The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial

PubMed Central

2014-01-01

Background Accidents are the leading cause of death in adults prior to middle age. The care of severely injured patients is an interdisciplinary challenge. Limited evidence is available concerning pre-hospital trauma care training programs and the advantage of such programs for trauma patients. The effect on trauma care procedures or on the safety of emergency crews on the scene is limited; however, there is a high level of experience and expert opinion. Methods I – Video-recorded case studies are the basis of an assessment tool and checklist being developed to verify the results of programs to train participants in the care of seriously injured patients, also known as “objective structured clinical examination” (OSCE). The timing, completeness and quality of the individual measures are assessed using appropriate scales. The evaluation of team communication and interaction will be analyzed with qualitative methods and quantified and verified by existing instruments (e.g. the Clinical Team Scale). The developed assessment tool is validated by several experts in the fields of trauma care, trauma research and medical education. II a) In a German emergency medical service, the subjective assessment of paramedics of their pre-hospital care of trauma patients is evaluated at three time points, namely before, immediately after and one year after training. b) The effect of a standardized course concept on the quality of documentation in actual field operations is determined based on three items relevant to patient safety before and after the course. c) The assessment tool will be used to assess the effect of a standardized course concept on procedures and team communication in pre-hospital trauma care using scenario-based case studies. Discussion This study explores the effect of training on paramedics. After successful study completion, further multicenter studies are conceivable, which would evaluate emergency-physician staffed teams. The influence on the patients and prehospital measures should be assessed based on a retrospective analysis of the emergency room data. Trials registration German Clinical Trials Register, ID DRKS00004713. PMID:24528532

Preparing Global Trauma Nurses for Leadership Roles in Global Trauma Systems.

PubMed

Muñiz, Sol Angelica; Lang, Richard W; Falcon, Lisa; Garces-King, Jasmine; Willard, Suzanne; Peck, Gregory L

Trauma leads to 5.7 million annual deaths globally, accounting for 25%-33% of global unintentional deaths and 90% of the global trauma burden in low- and middle-income countries. The Lancet Commission on Global Surgery and the World Health Organization assert that emergent and essential surgical capacity building and trauma system improvement are essential to address the global burden of trauma. In response, the Rutgers Global Surgery program, the School of Nursing and Medicine, and the Robert Wood Johnson University Hospital faculty collaborated in the first Interprofessional Models in Global Injury Care and Education Symposium in June 2016. This 2-week symposium combined lectures, high-fidelity simulation, small group workshops, site visits to Level I trauma centers, and a 1-day training course from the Panamerican Trauma Society. The aim was to introduce global trauma nurses to trauma leadership and trauma system development. After completing the symposium, 10 nurses from China, Colombia, Kenya, Puerto Rico, and Uruguay were surveyed. Overall, 88.8% of participants reported high levels of satisfaction with the program and 100% stated being very satisfied with trauma lectures. Symposia, such as that developed and offered by Rutgers University, prepare nurses to address trauma within system-based care and facilitate trauma nursing leadership in their respective countries.

Trauma Transitional Care Coordination: protecting the most vulnerable trauma patients from hospital readmission

PubMed Central

Hall, Erin C; Tyrrell, Rebecca; Scalea, Thomas M; Stein, Deborah M

2018-01-01

Background Unplanned hospital readmissions increase healthcare costs and patient morbidity. We hypothesized that a program designed to reduce trauma readmissions would be effective. Methods A Trauma Transitional Care Coordination (TTCC) program was created to support patients at high risk for readmission. TTCC interventions included call to patient (or caregiver) within 72 hours of discharge to identify barriers to care, complete medication reconciliation, coordination of appointments, and individualized problem solving. Information on all 30-day readmissions was collected. 30-day readmission rates were compared with center-specific readmission rates and population-based, risk-adjusted rates of readmission using published benchmarks. Results 260 patients were enrolled in the TTCC program from January 2014 to September 2015. 30.8% (n=80) of enrollees were uninsured, 41.9% (n=109) reported current substance abuse, and 26.9% (n=70) had a current psychiatric diagnosis. 74.2% (n=193) attended outpatient trauma appointments within 14 days of discharge. 96.3% were successfully followed. Only 6.6% (n=16) of patients were readmitted in the first 30 days after discharge. This was significantly lower than both center-specific readmission rates before start of the program (6.6% vs. 11.3%, P=0.02) and recently published population-based trauma readmission rates (6.6% vs. 27%, P<0.001). Discussion A nursing-led TTCC program successfully followed patients and was associated with a significant decrease in 30-day readmission rates for patients with high-risk trauma. Targeted outpatient support for these most vulnerable patients can lead to better utilization of outpatient resources, increased patient satisfaction, and more consistent attainment of preinjury level of functioning or better. Level of evidence Level IV. PMID:29766133

A Statewide Collaboration: Ohio Level III Trauma Centers' Approach to the Development of a Benchmarking System.

PubMed

Lang, Carrie L; Simon, Diane; Kilgore, Jane

The American College of Surgeons Committee on Trauma revised the Resources for Optimal Care of the Injured Patient to include the criteria for trauma centers to participate in a risk-adjusted benchmarking system. Trauma Quality Improvement Program is currently the risk-adjusted benchmarking program sponsored by the American College of Surgeons, which will be required of all trauma centers to participate in early 2017. Prior to this, there were no risk-adjusted programs for Level III verified trauma centers. The Ohio Society of Trauma Nurse Leaders is a collaborative group made up of trauma program managers, coordinators, and other trauma leaders who meet 6 times a year. Within this group, a Level III Subcommittee was formed initially to provide a place for the Level III centers to discuss issues specific to the Level III centers. When the new requirement regarding risk-adjustment became official, the subcommittee agreed to begin reporting simple data points with the idea to risk adjust in the future.

Layperson trauma training in low- and middle-income countries: a review.

PubMed

Callese, Tyler E; Richards, Christopher T; Shaw, Pamela; Schuetz, Steven J; Issa, Nabil; Paladino, Lorenzo; Swaroop, Mamta

2014-07-01

Prehospital trauma systems are rudimentary in many low- and middle-income countries (LMICs) and require laypersons to stabilize and transport injured patients. The World Health Organization recommends educating layperson first responders as an essential step in the development of Emergency Medical Services systems in LMICs. This systematic review examines trauma educational initiatives for layperson first responders in resource-poor settings. Layperson first-responder training and education program publications were identified using PubMed MEDLINE and Scopus databases. Articles addressing physicians, professional Emergency Medical Services training, or epidemiologic descriptions were excluded. Publications were assessed by independent reviewers, and those included underwent thematic analysis. Thirteen publications met inclusion criteria. Four themes emerged regarding the development of layperson first-responder training programs: (1) An initial needs assessment of a region's existing trauma system of care and laypersons' baseline emergency care knowledge focuses subsequent educational interventions; (2) effective programs adapt to and leverage existing resources; (3) training methods should anticipate participants with low levels of education and literacy; and (4) postimplementation evaluation allows for curriculum improvement. Technology, such as online and remote learning platforms, can be used to operationalize each theme. Successful training programs for layperson first responders in LMICs identify and maximize existing resources are adaptable to learners with little formal education and are responsive to postimplementation evaluation. Educational platforms that leverage technology to deliver content may facilitate first-responder trauma education in underresourced areas. Themes identified can inform the development of trauma systems of care to decrease mortality and physiological severity scores in trauma patients in LMICs. Copyright © 2014 Elsevier Inc. All rights reserved.

Durable medical equipment recycling: a pilot program.

PubMed

Wright, Aaron J

2012-01-01

Our unfunded trauma patients often lack the access to adequate health care services and equipment after hospital discharge. We have developed and implemented a pilot program to provide reclaimed durable medical equipment to medically indigent trauma patients. Our program includes the reuse of items such as front-wheeled walkers, bedside commodes, shower chairs, crutches, and canes.

[The Academy of Trauma Surgery (AUC). Service provider and management organization of the DGU].

PubMed

Sturm, J A; Hoffmann, R

2016-02-01

At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and training, e.g. advanced trauma life support (ATLS®) and other training programs including the innovative interpersonal competence (IC) course.

Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After Orthopaedic Trauma.

PubMed

Wegener, Stephen T; Carroll, Eben A; Gary, Joshua L; McKinley, Todd O; OʼToole, Robert V; Sietsema, Debra L; Castillo, Renan C; Frey, Katherine P; Scharfstein, Daniel O; Huang, Yanjie; Collins, Susan C J; MacKenzie, Ellen J

2017-08-01

The impact of the Trauma Collaborative Care (TCC) program on surgeon confidence in managing the psychosocial sequelae of orthopaedic trauma was evaluated as part of a larger prospective, multisite, cluster clinical trial. We compared confidence and perceived resource availability among surgeons practicing in trauma centers that implemented the TCC program with orthopaedic trauma surgeons in similar trauma centers that did not implement the TCC. Prospective cohort design. Level-I trauma centers. Attending surgeons and fellows (N = 95 Pre and N = 82 Post). Self-report 10-item measure of surgeon confidence in managing psychosocial issues associated with trauma and perceived availability of support resources. Analyses, performed on the entire sample and repeated on the subset of 52 surgeons who responded to the survey at both times points, found surgeons at intervention sites experienced a significantly greater positive improvement (P < 0.05) in their (1) belief that they have strategies to help orthopaedic trauma patients change their psychosocial situation; (2) confidence in making appropriate referrals for orthopaedic trauma patients with psychosocial problems; and (3) belief that they have access to information to guide the management of psychosocial issues related to recovery. Initial data suggest that the establishment of the TCC program can improve surgeons' perceived availability of resources and their confidence in managing the psychosocial sequelae after injury. Further studies will be required to determine if this translates into beneficial patient effects. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Health care reform at trauma centers--mortality, complications, and length of stay.

PubMed

Shafi, Shahid; Barnes, Sunni; Nicewander, David; Ballard, David; Nathens, Avery B; Ingraham, Angela M; Hemmila, Mark; Goble, Sandra; Neal, Melanie; Pasquale, Michael; Fildes, John J; Gentilello, Larry M

2010-12-01

The Trauma Quality Improvement Program has demonstrated existence of significant variations in risk-adjusted mortality across trauma centers. However, it is unknown whether centers with lower mortality rates also have reduced length of stay (LOS), with associated cost savings. We hypothesized that LOS is not primarily determined by unmodifiable factors, such as age and injury severity, but is primarily dependent on the development of potentially preventable complications. The National Trauma Data Bank (2002-2006) was used to include patients (older than 16 years) with at least one severe injury (Abbreviated Injury Scale score ≥ 3) from Level I and II trauma centers (217,610 patients, 151 centers). A previously validated risk-adjustment algorithm was used to calculate observed-to-expected mortality ratios for each center. Poisson regression was used to determine the relationship between LOS, observed-to-expected mortality ratios, and complications while controlling for confounding factors, such as age, gender, mechanism, insurance status, comorbidities, and injuries and their severity. Large variations in LOS (median, 4-8 days) were observed across trauma centers. There was no relationship between mortality and LOS. The most important predictor of LOS was complications, which were associated with a 62% increase. Injury severity score, shock, gunshot wounds, brain injuries, intensive care unit admission, and comorbidities were less important predictors of LOS. Quality improvement programs focusing on mortality alone may not be associated with reduced LOS. Hence, the Trauma Quality Improvement Program should also focus on processes of care that reduce complications, thereby shortening LOS, which may lead to significant cost savings at trauma centers.

Continuing Care and Trauma in Women Offenders’ Substance Use, Psychiatric Status, and Self-Efficacy Outcomes

PubMed Central

Saxena, Preeta; Grella, Christine E.; Messina, Nena P.

2015-01-01

Using secondary data analysis of 3 separate trauma-informed treatment programs for women offenders, we examine outcomes between those who received both prison and community-based substance abuse treatment (i.e., continuing care; n = 85) and those who received either prison or community aftercare treatment (n = 108). We further account for differences in trauma exposure to examine whether continuing care moderates this effect on substance use, psychiatric severity, and self-efficacy outcomes at follow-up. The main effect models of continuing care showed a significant association with high psychiatric status and did not yield significant associations with substance use or self-efficacy. However, the interaction between trauma history and continuing care showed significant effects on all 3 outcomes. Findings support the importance of a continuing care treatment model for women offenders exposed to multiple forms of traumatic events, and provide evidence of the effectiveness of integrating trauma-informed treatment into women’s substance abuse treatment. PMID:26924891

Interprofessional Flight Camp.

PubMed

Alfes, Celeste M; Rowe, Amanda S

2016-01-01

The Dorothy Ebersbach Academic Center for Flight Nursing in Cleveland, OH, holds an annual flight camp designed for master's degree nursing students in the acute care nurse practitioner program, subspecializing in flight nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University. The weeklong interprofessional training is also open to any health care provider working in an acute care setting and focuses on critical care updates, trauma, and emergency care within the critical care transport environment. This year, 29 graduate nursing students enrolled in a master's degree program from Puerto Rico attended. Although the emergency department in Puerto Rico sees and cares for trauma patients, there is no formal trauma training program. Furthermore, the country only has 1 rotor wing air medical transport service located at the Puerto Rico Medical Center in San Juan. Flight faculty and graduate teaching assistants spent approximately 9 months planning for their participation in our 13th annual flight camp. Students from Puerto Rico were extremely pleased with the learning experiences at camp and expressed particular interest in having more training time within the helicopter flight simulator. Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Trauma-Informed Day Services for Individuals with Intellectual/Developmental Disabilities: Exploring Staff Understanding and Perception within an Innovative Programme

ERIC Educational Resources Information Center

Keesler, John M.

2016-01-01

Background: Trauma-informed care (TIC) is a systems-level philosophy of service delivery which integrates choice, collaboration, empowerment, safety and trust to create an organizational culture sensitive to trauma. This study explores staff understandings and perceptions within an innovative trauma-informed day program for individuals with…

Medical Readiness. Efforts Are Underway for DOD Training in Civilian Trauma Centers.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. National Security and International Affairs Div.

This report evaluates a Department of Defense (DOD) demonstration program that would provide trauma care training for military medical personnel through one or more public or nonprofit hospitals. Specifically, it examines DOD's actions to meet legislative requirements of the demonstration program; identifies other initiatives aimed at training…

Improving teamwork and communication in trauma care through in situ simulations.

PubMed

Miller, Daniel; Crandall, Cameron; Washington, Charles; McLaughlin, Steven

2012-05-01

Teamwork and communication often play a role in adverse clinical events. Due to the multidisciplinary and time-sensitive nature of trauma care, the effects of teamwork and communication can be especially pronounced in the treatment of the acutely injured patient. Our hypothesis was that an in situ trauma simulation (ISTS) program (simulating traumas in the trauma bay with all members of the trauma team) could be implemented in an emergency department (ED) and that this would improve teamwork and communication measured in the clinical setting. This was an observational study of the effect of an ISTS program on teamwork and communication during trauma care. The authors observed a convenience sample of 39 trauma activations. Cases were selected by their presenting to the resuscitation bay of a Level I trauma center between 09:00 and 16:00, Monday through Thursday, during the study period. Teamwork and communication were measured using the previously validated Clinical Teamwork Scale (CTS). The observers were three Trauma Nursing Core Course certified RNs trained on the CTS by observing simulated and actual trauma cases and following each of these cases with a discussion of appropriate CTS scores with two certified Advanced Trauma Life Support instructors/emergency physicians. Cases observed for measurement were scored in four phases: 1) preintervention phase (baseline); 2) didactic-only intervention, the phase following a lecture series on teamwork and communication in trauma care; 3) ISTS phase, real trauma cases scored during period when weekly ISTSs were performed; and 4) potential decay phase, observations following the discontinuation of the ISTSs. Multirater agreement was assessed with Krippendorf's alpha coefficient; agreement was excellent (mean agreement = 0.92). Nonparametric procedures (Kruskal-Wallis) were used to test the hypothesis that the scores observed during the various phases were different and to compare each individual phase to baseline scores. The ISTS program was implemented and achieved regular participation of all components of our trauma team. Data were collected on 39 cases. The scores for 11 of 14 measures improved from the baseline to the didactic phase, and the mean and median scores of all CTS component measures were greatest during the ISTS phase. When each phase was compared to baseline scores, using the baseline as a control, there were no significant differences seen during the didactic or the decay phases, but 12 of the 14 measures showed significant improvements from the baseline to the simulation phase. However, when the Kruskal-Wallis test was used to test for differences across all phases, only overall communication showed a significant difference. During the potential decay phase, the scores for every measure returned to baseline phase values. This study shows that an ISTS program can be implemented with participation from all members of a multidisciplinary trauma team in the ED of a Level I trauma center. While teamwork and communication in the clinical setting were improved during the ISTS program, this effect was not sustained after ISTS were stopped. © 2012 by the Society for Academic Emergency Medicine.

Trafficking and Trauma: Insight and Advice for the Healthcare System From Sex-trafficked Women Incarcerated on Rikers Island.

PubMed

Ravi, Anita; Pfeiffer, Megan R; Rosner, Zachary; Shea, Judy A

2017-12-01

Sex-trafficked persons experience significant trauma while exploited, resulting in complex health issues and barriers to health care. Incorporating survivor perspectives is critical in optimizing health care delivery for this population. We interviewed sex-trafficking survivors regarding their experiences with trauma while being trafficked and elicited advice about health care delivery. Qualitative interviews were conducted in New York City's Rikers Island jail from July to September 2015. In total, 21 English-speaking women who had experienced sex trafficking were the subjects of the study. Interview domains included: interpersonal violence, behavioral health, and health care delivery advice. Interviewees described experiencing severe and chronic trauma perpetrated by traffickers and sex buyers. Substance use was the primary method of coping with trauma. With regard to mental health, interviewees noted diagnoses of depression, anxiety and posttraumatic stress disorder, low self-esteem, and challenges in intimate relationships. Health care delivery themes included approaches to discussing trafficking in health care settings, concerns regarding sexual assault examinations, and suggestions for improving direct-services and prevention programming. With this perspective into the complex intersection of trauma and behavioral health that sex-trafficked women can experience, health care providers can better understand the context and recommendations regarding trauma-informed care practices for this population. Our results also offer several avenues for future studies with regard to discussing trafficking in clinical settings and an opportunity for stakeholders to incorporate survivor-based input to improve health care for this population.

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

PubMed

Peters, V Kristen; Harvey, Ellen M; Wright, Andi; Bath, Jennifer; Freeman, Dan; Collier, Bryan

2018-01-01

Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

"Trauma, stress, and self-care in clinical training: Predictors of burnout, decline in health status, secondary traumatic stress symptoms, and compassion satisfaction": Correction to Butler, Carello, and Maguin (2016).

PubMed

2017-07-01

Reports an error in "Trauma, stress, and self-care in clinical training: Predictors of burnout, decline in health status, secondary traumatic stress symptoms, and compassion satisfaction" by Lisa D. Butler, Janice Carello and Eugene Maguin ( Psychological Trauma: Theory, Research, Practice, and Policy , Advanced Online Publication, Sep 12, 2016, np). In the article, there was an error in Table 4 of the Results. The Outcomes and Predictors columns were not clearly categorized from one another. The corrected table is present in the erratum. (The following abstract of the original article appeared in record 2016-43766-001.) Objective: Courtois and Gold (2009) have called for the inclusion of trauma in the curriculum for all mental health training programs. The present study investigated the impact of trauma-related content, stress, and self-care (SC) on trainees in such a program. Method: The study examined potential risk factors (trauma exposures in training [being faced with or reacting to trauma-related field work experiences and course content] and perceptions of stress in field and coursework) and protective factors (SC effort and importance) in relation to burnout (BO), health status (HS), secondary traumatic stress symptoms (STSS), and compassion satisfaction (CS) among 195 students in a graduate social work training program. Results: All students reported trauma exposures in their field placements and/or coursework, including retraumatization experiences that were associated with higher STSS and BO. Field stress and SC effort were both consistent predictors across outcomes. Higher field stress levels predicted higher BO and STSS, a greater likelihood of decline in HS, and lower CS. Lower SC effort was also associated with higher BO and STSS, and a greater likelihood of decline in HS, while higher SC effort predicted higher CS. Older students, those with traumatized field clients, and those whose field work addressed trauma, also reported higher CS. Conclusions: These findings suggest that clinical training involving trauma content can be both rewarding and stressful, and may evoke distress in some trainees. Given that learning about and working with trauma are essential to adequate clinical training, the authors suggest adopting a trauma-informed approach within clinical training programs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Structure, Process, and Culture of Intensive Care Units Treating Patients with Severe Traumatic Brain Injury: Survey of Centers Participating in the American College of Surgeons Trauma Quality Improvement Program.

PubMed

Alali, Aziz S; McCredie, Victoria A; Mainprize, Todd G; Gomez, David; Nathens, Avery B

2017-10-01

Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI. One hundred forty-two TMDs (76%) completed the survey. Severe TBI patients are admitted to dedicated neurocritical care units in 52 hospitals (37%), trauma ICUs in 44 hospitals (31%), general ICUs in 34 hospitals (24%), and surgical ICUs in 11 hospitals (8%). Fifty-seven percent are closed units. Board-certified intensivists directed 89% of ICUs, whereas 17% were led by neurointensivists. Sixty percent of ICU directors were general surgeons. Thirty-nine percent of hospitals had critical care fellowships and 11% had neurocritical care fellowships. Fifty-nine percent of ICUs had standard order sets and 61% had standard protocols specific for TBI, with the most common protocol relating to intracranial pressure management (53%). Only 43% of TMDs were satisfied with the current level of neurosurgeons' engagement in the ICU management of TBI; 46% believed that neurosurgeons should be more engaged; 11% believed they should be less engaged. In the largest survey of North American ICUs caring for TBI patients, there is substantial variation in the current approaches to ICU care for TBI, highlighting multiple opportunities for comparative effectiveness research.

Injury and violence in Los Angeles. Impact on access to health care and surgical education.

PubMed

Fleming, A W; Sterling-Scott, R P; Carabello, G; Imari-Williams, I; Allmond, B; Foster, R S; Kennedy, F; Shoemaker, W C

1992-06-01

The Los Angeles County (California) Trauma Hospital System was designed to ensure that all patients requiring specialized trauma care would be transported directly to a trauma center using established trauma triage criteria. The designation and implementation of all level 1, 2, and 3 (rural) trauma centers were completed between October 1983 and July 1985. However, by February 1, 1985, one level 2 trauma center withdrew, and nine other level 2 and 3 trauma centers followed suit over the next few months and years. The reasons for closure of these 10 trauma centers were almost exclusively related to economic factors. The major impact of trauma center closure on surgical educational programs at the Drew University of Medicine and Science and the Martin Luther King, Jr/Charles R. Drew Medical Center have been additive and cumulative. The high volume of patients with trauma has been cited, sometimes correctly and sometimes incorrectly, as the primary reason for a lack of access to health care for patients without trauma. We have developed a blueprint for survival that, when fully implemented, will improve access to health care for all residents in our catchment area and optimize surgical education. While the Los Angeles County Trauma Hospital System has had many difficulties during the last 9 years, the population it serves is greater than that in 42 states in the United States. The experiences gained in Los Angeles County may be beneficial to statewide systems in the United States and in countries of comparable size.

The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system.

PubMed

Saillant, N N; Earl-Royal, E; Pascual, J L; Allen, S R; Kim, P K; Delgado, M K; Carr, B G; Wiebe, D; Holena, D N

2017-02-01

Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers. PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. III. Descriptive.

Implementing Major Trauma Audit in Ireland.

PubMed

Deasy, Conor; Cronin, Marina; Cahill, Fiona; Geary, Una; Houlihan, Patricia; Woodford, Maralyn; Lecky, Fiona; Mealy, Ken; Crowley, Philip

2016-01-01

There are 27 receiving trauma hospitals in the Republic of Ireland. There has not been an audit system in place to monitor and measure processes and outcomes of care. The National Office of Clinical Audit (NOCA) is now working to implement Major Trauma Audit (MTA) in Ireland using the well-established National Health Service (NHS) UK Trauma Audit and Research Network (TARN). The aim of this report is to highlight the implementation process of MTA in Ireland to raise awareness of MTA nationally and share lessons that may be of value to other health systems undertaking the development of MTA. The National Trauma Audit Committee of the Royal College of Surgeons in Ireland, consisting of champions and stakeholders in trauma care, in 2010 advised on the adaptation of TARN for Ireland. In 2012, the Emergency Medicine Program endorsed TARN and in setting up the National Emergency Medicine Audit chose MTA as the first audit project. A major trauma governance group was established representing stakeholders in trauma care, a national project co-ordinator was recruited and a clinical lead nominated. Using Survey Monkey, the chief executives of all trauma receiving hospitals were asked to identify their hospital's trauma governance committee, trauma clinical lead and their local trauma data co-ordinator. Hospital Inpatient Enquiry systems were used to identify to hospitals an estimate of their anticipated trauma audit workload. There are 25 of 27 hospitals now collecting data using the TARN trauma audit platform. These hospitals have provided MTA Clinical Leads, allocated data co-ordinators and incorporated MTA reports formally into their clinical governance, quality and safety committee meetings. There has been broad acceptance of the NOCA escalation policy by hospitals in appreciation of the necessity for unexpected audit findings to stimulate action. Major trauma audit measures trauma patient care processes and outcomes of care to drive quality improvement at hospital and national level. MTA will facilitate the strategic development of trauma care in Ireland by monitoring processes and outcomes and the effects of changes in trauma service provision. Copyright © 2015 Elsevier Ltd. All rights reserved.

Moving from "optimal resources" to "optimal care" at trauma centers.

PubMed

Shafi, Shahid; Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Gentilello, Larry M; Ballard, David

2012-04-01

The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. Records of a random sample of 1,000 patients admitted to a Level I trauma center who met Trauma Quality Improvement Program criteria (age ≥ 16 years and Abbreviated Injury Scale score 3) were retrospectively reviewed for compliance with 25 trauma-specific POC (T-POC) that were evidence-based or expert consensus panel recommendations. Multivariate regression was used to determine the relationship between T-POC compliance and in-hospital mortality, adjusted for age, gender, injury type, and severity. Median age was 41 years, 65% were men, 88% sustained a blunt injury, and mortality was 12%. Of these, 77% were eligible for at least one T-POC and 58% were eligible for two or more. There was wide variation in T-POC compliance. Every 10% increase in compliance was associated with a 14% reduction in risk-adjusted in-hospital mortality. Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.

Leadership and Teamwork in Trauma and Resuscitation.

PubMed

Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

2016-09-01

Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance. Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership's effect on patient-level outcome.

Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

PubMed

Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

2013-01-01

Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Orthopaedic trauma care in Haiti: a cost-effectiveness analysis of an innovative surgical residency program.

PubMed

Carlson, Lucas C; Slobogean, Gerard P; Pollak, Andrew N

2012-01-01

In an effort to sustainably strengthen orthopaedic trauma care in Haiti, a 2-year Orthopaedic Trauma Care Specialist (OTCS) program for Haitian physicians has been developed. The program will provide focused training in orthopaedic trauma surgery and fracture care utilizing a train-the-trainer approach. The purpose of this analysis was to calculate the cost-effectiveness of the program relative to its potential to decrease disability in the Haitian population. Using established methodology originally outlined in the World Health Organization's Global Burden of Disease project, a cost-effectiveness analysis was performed for the OTCS program in Haiti. Costs and disability-adjusted life-years (DALYs) averted were estimated per fellow trained in the OTCS program by using a 20-year career time horizon. Probabilistic sensitivity analysis was used to simultaneously test the joint uncertainty of the cost and averted DALY estimates. A willingness-to-pay threshold of $1200 per DALY averted, equal to the gross domestic product per capita in Haiti, was selected on the basis of World Health Organization's definition of highly cost-effective health interventions. The OTCS program results in an incremental cost of $1,542,544 ± $109,134 and 12,213 ± 2,983 DALYs averted per fellow trained. The cost-effectiveness ratio of $133.97 ± $34.71 per DALY averted is well below the threshold of $1200 per DALY averted. Furthermore, sensitivity analysis suggests that implementing the OTCS program is the economically preferred strategy with more than 95% probability at a willingness-to-pay threshold of $200 per DALY averted and across the entire range of potential variable inputs. The current economic analysis suggests the OTCS program to be a highly cost-effective intervention. Probabilistic sensitivity analysis demonstrates that the conclusions remain stable even when considering the joint uncertainty of the cost and DALY estimates. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Saving lives and saving money: hospital-based violence intervention is cost-effective.

PubMed

Juillard, Catherine; Smith, Randi; Anaya, Nancy; Garcia, Arturo; Kahn, James G; Dicker, Rochelle A

2015-02-01

Victims of violence are at significant risk for injury recidivism, including fatality. We previously demonstrated that our hospital-based violence intervention program (VIP) resulted in a fourfold reduction in injury recidivism, avoiding trauma care costs of $41,000 per injury. Given limited trauma center resources, assessing cost-effectiveness of interventions is fundamental to inform use of these programs in other institutions. This study examines the cost-effectiveness of hospital-based VIP. We used a decision tree and Markov disease state modeling to analyze cost utility for a hypothetical cohort of violently injured subjects, comparing VIP versus no VIP at a trauma center. Quality-adjusted life-years (QALYs) were calculated using differences in mortality and published health state utilities. Costs of trauma care and VIP were obtained from institutional data, and risk of recidivism with and without VIP were obtained from our trial. Outcomes were QALYs gained and net costs over a 5-year horizon. Sensitivity analyses examined the impact of uncertainty in input values on results. VIP results in an estimated 25.58 QALYs and net costs (program plus trauma care) of $5,892 per patient. Without VIP, these values are 25.34 and $5,923, respectively, suggesting that VIP yields substantial health benefits (24 QALYs) and savings ($4,100) if implemented for 100 individuals. In the sensitivity analysis, net QALYs gained with VIP nearly triple when the injury recidivism rate without VIP is highest. Cost-effectiveness remained robust over a range of values; $6,000 net cost savings occur when 5-year recidivism rate without VIP is at 7%. VIP costs less than having no VIP with significant gains in QALYs especially at anticipated program scale. Across a range of plausible values at which VIP would be less cost-effective (lower injury recidivism, cost of injury, and program effectiveness), VIP still results in acceptable cost per health outcome gained. VIP is effective and cost-effective and should be considered in any trauma center that takes care of violently injured patients. Our analyses can be used to estimate VIP costs and results in different settings. Economic and value-based evaluation, level 2.

Primary prevention of pediatric abusive head trauma: a cost audit and cost-utility analysis.

PubMed

Friedman, Joshua; Reed, Peter; Sharplin, Peter; Kelly, Patrick

2012-01-01

To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program. A 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs. There were 52 cases of abusive head trauma in the sample. Hospital costs totaled $NZ2,433,340, child protection $NZ1,560,123, police investigation $NZ1,842,237, criminal trials $NZ3,214,020, punishment of offenders $NZ4,411,852 and community rehabilitation $NZ2,895,848. Projected education costs for disabled survivors were $NZ2,452,148, and the cost of projected lifetime care was $NZ33,624,297. Total costs were $NZ52,433,864, averaging $NZ1,008,344 per child. Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes. Pediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs. If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost-benefit analysis in the field of abusive head trauma prevention. Copyright © 2012 Elsevier Ltd. All rights reserved.

Using the FAN Approach to Deepen Trauma-Informed Care for Infants, Toddlers, and Families

ERIC Educational Resources Information Center

Heffron, Mary Claire; Gilkerson, Linda; Cosgrove, Kimberly; Heller, Sherryl Scott; Imberger, Jaci; Leviton, Audrey; Mueller, Mary; Norris-Shortle, Carole; Phillips, Caroline; Spielman, Eda; Wasserman, Kate

2016-01-01

Erikson Institute Fussy Baby Network® (FBN) leaders from around the country have been considering the importance of building trauma-informed service programs. In this article, they discuss ways that the Facilitating Attuned Interaction (FAN) approach and the core processes used by the FAN can be helpful both when trauma is an unexpected presence…

Rates of trauma-informed counseling at substance abuse treatment facilities: reports from over 10,000 programs.

PubMed

Capezza, Nicole M; Najavits, Lisa M

2012-04-01

Trauma-informed treatment increasingly is recognized as an important component of service delivery. This study examined differences in treatment-related characteristics of facilities that offer moderate or high levels of trauma-informed counseling versus those that offer no or low levels of such counseling. Responses from 13,223 substance abuse treatment facilities surveyed in 2009 by the National Survey of Substance Abuse Treatment Services (NSSATS) were used. A majority (66.6%) of facilities reported using trauma counseling sometimes or always or often. Facilities that provided moderate or high levels of trauma counseling were more likely to provide additional treatment services, such as disease testing and specialized group therapy, as well as child care, employment counseling, and other ancillary services. A majority of facilities reported provision of trauma counseling. Additional training and resources may be needed for programs that reported low rates of trauma counseling.

[Occupational exposure to blood in multiple trauma care].

PubMed

Wicker, S; Wutzler, S; Schachtrupp, A; Zacharowski, K; Scheller, B

2015-01-01

Trauma care personnel are at risk of occupational exposure to blood-borne pathogens. Little is known regarding compliance with standard precautions or occupational exposure to blood and body fluids among multiple trauma care personnel in Germany. Compliance rates of multiple trauma care personnel in applying standard precautions, knowledge about transmission risks of blood-borne pathogens, perceived risks of acquiring hepatitis B, hepatitis C and human immunodeficiency virus (HIV) and the personal attitude towards testing of the index patient for blood-borne pathogens after a needlestick injury were evaluated. In the context of an advanced multiple trauma training an anonymous questionnaire was administered to the participants. Almost half of the interviewees had sustained a needlestick injury within the last 12 months. Approximately three quarters of the participants were concerned about the risk of HIV and hepatitis. Trauma care personnel had insufficient knowledge of the risk of blood-borne pathogens, overestimated the risk of hepatitis C infection and underused standard precautionary measures. Although there was excellent compliance for using gloves, there was poor compliance in using double gloves (26.4 %), eye protectors (19.7 %) and face masks (15.8 %). The overwhelming majority of multiple trauma care personnel believed it is appropriate to test an index patient for blood-borne pathogens following a needlestick injury. The process of treatment in prehospital settings is less predictable than in other settings in which invasive procedures are performed. Periodic training and awareness programs for trauma care personnel are required to increase the knowledge of occupational infections and the compliance with standard precautions. The legal and ethical aspects of testing an index patient for blood-borne pathogens after a needlestick injury of a healthcare worker have to be clarified in Germany.

International trauma teleconference: evaluating trauma care and facilitating quality improvement.

PubMed

Parra, Michael W; Castillo, Roberto C; Rodas, Edgar B; Suarez-Becerra, Jose M; Puentes-Manosalva, Fabian E; Wendt, Luke M

2013-09-01

Evaluation, development, and implementation of trauma systems in Latin America are challenging undertakings as no model is currently in place that can be easily replicated throughout the region. The use of teleconferencing has been essential in overcoming other challenges in the medical field and improving medical care. This article describes the use of international videoconferencing in the field of trauma and critical care as a tool to evaluate differences in care based on local resources, as well as facilitating quality improvement and system development in Latin America. In February 2009, the International Trauma and Critical Care Improvement Project was created and held monthly teleconferences between U.S. trauma surgeons and Latin American general surgeons, emergency physicians, and intensivists. In-depth discussions and prospective evaluations of each case presented were conducted by all participants based on resources available. Care rendered was divided in four stages: (1) pre-hospital setting, (2) emergency room or trauma room, (3) operating room, and (4) subsequent postoperative care. Furthermore, the participating institutions completed an electronic survey of trauma resources based on World Health Organization/International Association for Trauma and Surgical Intensive Care guidelines. During a 17-month period, 15 cases in total were presented from a Level I and a Level II U.S. hospital (n=3) and five Latin American hospitals (n=12). Presentations followed the Advanced Trauma Life Support sequence in all U.S. cases but in only 3 of the 12 Latin American cases. The following deficiencies were observed in cases presented from Latin America: pre-hospital communication was nonexistent in all cases; pre-hospital services were absent in 60% of cases presented; lack of trauma team structure was evident in the emergency departments; during the initial evaluation and resuscitation, the Advanced Trauma Life Support protocol was followed one time and the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage protocol on two occasions; it was determined that imaging resources were adequately used in half of the cases; the initial care was mostly provided by emergency room physicians; and a surgeon, operating room, and intensive care unit were not readily available 83% of the time. The ease of patient flow was cumbersome because of a lack of a structured system for trauma care except for one academic urban center. Adequate trauma resources are present in less than 50% of the time. Multidisciplinary resources, quality improvement programs, protocols, and guidelines were deficient. A well-structured international teleconference can be used as a dynamic window of observation to evaluate and identify deficiencies in trauma care in the Latin American region. These findings can be used to formulate specific recommendations based on local resources. Furthermore, by raising local awareness, leaders could be identified to become the executors of more efficient healthcare policies that can potentially affect trauma care.

Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program.

PubMed

Jayaraman, Sudha; Mabweijano, Jacqueline R; Lipnick, Michael S; Caldwell, Nolan; Miyamoto, Justin; Wangoda, Robert; Mijumbi, Cephas; Hsia, Renee; Dicker, Rochelle; Ozgediz, Doruk

2009-12-01

Uganda currently has no organized prehospital emergency system. We sought to measure the current burden of injury seen by lay people in Kampala, Uganda and to determine the feasibility of a lay first-responder training program. We conducted a cross-sectional survey of current prehospital care providers in Kampala: police officers, minibus taxi drivers, and Local Council officials, and collected data on types and frequencies of emergencies witnessed, barriers to aid provision, history of training, and current availability of first-aid supplies. A context-appropriate course on basic first-aid for trauma was designed and implemented. We measured changes in trainees' fund of knowledge before and after training. A total of 309 lay people participated in the study, and during the previous 6 months saw 18 traumatic emergencies each; 39% saw an injury-related death. The most common injury mechanisms were road crashes, assault, and burns. In these cases, 90% of trainees provided some aid, most commonly lifting (82%) or transport (76%). Fifty-two percent of trainees had previous first-aid training, 44% had some access to equipment, and 32% had ever purchased a first-aid kit. Before training, participants answered 45% of test questions correctly (mean %) and this increased to 86% after training (p < 0.0001). Lay people witness many emergencies and deaths in Kampala, Uganda and provide much needed care but are ill-prepared to do so. A context-appropriate prehospital trauma care course can be developed and improve lay people's knowledge of basic trauma care. The effectiveness of such a training program needs to be evaluated prospectively.

Achieving Service Change Through the Implementation of a Trauma-Informed Care Training Program Within a Mental Health Service.

PubMed

Palfrey, Nicola; Reay, Rebecca E; Aplin, Velissa; Cubis, Jeffery C; McAndrew, Virginia; Riordan, Denise M; Raphael, Beverley

2018-04-28

As evidence continues to accumulate for the association between childhood trauma and long-term adverse outcomes, Trauma-Informed Care (TIC) approaches are emerging as fundamental to contemporary mental health services. To evaluate a workshop designed to influence mental health practitioners in TIC principles and practices. Nursing, medical and allied health professionals completed pre and post measures of confidence, awareness and attitudes towards TIC practice. The workshop was rated as highly relevant and useful to clinician's practice. Participants' self-reported confidence, awareness and attitudes towards TIC significantly increased (p < .001) and the perceived number of barriers to working within a TIC framework significantly decreased (p < .05). Child and Adolescent Mental Health clinicians routinely screened for trauma and 80% had received training in a trauma specific intervention at follow-up. This brief training provides an important foundation for the development of trauma-informed, evidence-based mental health services.

A crew resource management program tailored to trauma resuscitation improves team behavior and communication.

PubMed

Hughes, K Michael; Benenson, Ronald S; Krichten, Amy E; Clancy, Keith D; Ryan, James Patrick; Hammond, Christopher

2014-09-01

Crew Resource Management (CRM) is a team-building communication process first implemented in the aviation industry to improve safety. It has been used in health care, particularly in surgical and intensive care settings, to improve team dynamics and reduce errors. We adapted a CRM process for implementation in the trauma resuscitation area. An interdisciplinary steering committee developed our CRM process to include a didactic classroom program based on a preimplementation survey of our trauma team members. Implementation with new cultural and process expectations followed. The Human Factors Attitude Survey and Communication and Teamwork Skills assessment tool were used to design, evaluate, and validate our CRM program. The initial trauma communication survey was completed by 160 team members (49% response). Twenty-five trauma resuscitations were observed and scored using Communication and Teamwork Skills. Areas of concern were identified and 324 staff completed our 3-hour CRM course during a 3-month period. After CRM training, 132 communication surveys and 38 Communication and Teamwork Skills observations were completed. In the post-CRM survey, respondents indicated improvement in accuracy of field to medical command information (p = 0.029); accuracy of emergency department medical command information to the resuscitation area (p = 0.002); and team leader identity, communication of plan, and role assignment (p = 0.001). After CRM training, staff were more likely to speak up when patient safety was a concern (p = 0.002). Crew Resource Management in the trauma resuscitation area enhances team dynamics, communication, and, ostensibly, patient safety. Philosophy and culture of CRM should be compulsory components of trauma programs and in resuscitation of injured patients. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The US Department of Defense Hemorrhage and Resuscitation Research and Development Program.

PubMed

Pusateri, Anthony E; Dubick, Michael A

2015-08-01

Data from recent conflicts demonstrate the continuing need for research and development focusing on hemorrhage control, fluid resuscitation, blood products, transfusion, and pathophysiologic responses to traumatic hemorrhage. The US Department of Defense Hemorrhage and Resuscitation Research and Development Program brings together US Department of Defense efforts and is coordinated with efforts of our other federal government, industry, international, and university-based partners. Military medical research has led to advances in both military and civilian trauma care. A sustained effort will be required to continue to advance the care of severely injured trauma patients.

A Dedicated Satellite Trauma Orthopaedic Program Operating Room Safely Increases Capacity.

PubMed

Waters, Peter M; Yang, Brian W; White, Doreen; Barth, Ellen; Chiang, Vincent; Mizrahi-Arnaud, Arielle; Sparks, William

2018-05-16

Providing high-value care for urgent orthopaedic trauma patients requires effective and timely treatment. Herein, we describe the implementation of an innovative program utilizing the operating room (OR) capacity of a satellite campus to decrease stress on a pediatric tertiary care center without jeopardizing patient safety. In addition to the daily emergency surgical room on the main campus, a dedicated orthopaedic trauma surgery OR was established in a satellite hospital location for 3 days per week in the summer and for 2 days per week for the rest of the year. Nonemergency, non-multitrauma operative fracture cases presenting to our tertiary care facility emergency department or orthopaedic clinic were considered for satellite referral. Eligible patients required clearance for transfer via orthopaedic, emergency department, and anesthesia checklists. An opt-out policy was established for provider judgment or patient family concern to overrule transfer decisions. Selected patients were discharged home with satellite OR scheduling or approved for same-day satellite location admission. Short elective cases were performed when openings existed in the schedule. From June 1, 2016, through June 30, 2017, 480 cases (372 trauma, 108 elective) were completed in our satellite OR. The most common trauma cases that were treated in the satellite OR were type-II supracondylar humeral fractures (n = 76). Summer months averaged 41.75 trauma cases and 11.25 elective cases per month, with 3.15 trauma cases and 0.85 elective cases per day. Nonsummer months averaged 22.78 trauma cases and 7.00 elective cases per month, with 2.93 trauma and 0.90 elective cases per day. Of the 17 postoperative issues, the greatest number (n = 7 [41%]) involved symptomatic hardware. The remaining complications were not surgeon or geographic-site-specific. There were no intraoperative complications, compartment syndrome episodes, or patients who required transfer back to our tertiary care facility for unexpected or serious medical issues. With the proper screening protocols in place for appropriate patient selection, the use of a dedicated satellite orthopaedic trauma OR can increase capacity without compromising patient safety.

Trauma, stress, and self-care in clinical training: Predictors of burnout, decline in health status, secondary traumatic stress symptoms, and compassion satisfaction.

PubMed

Butler, Lisa D; Carello, Janice; Maguin, Eugene

2017-07-01

[Correction Notice: An Erratum for this article was reported in Vol 9(4) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2016-54155-001). In the article, there was an error in Table 4 of the Results. The Outcomes and Predictors columns were not clearly categorized from one another. The corrected table is present in the erratum.] Objective: Courtois and Gold (2009) have called for the inclusion of trauma in the curriculum for all mental health training programs. The present study investigated the impact of trauma-related content, stress, and self-care (SC) on trainees in such a program. Method: The study examined potential risk factors (trauma exposures in training [being faced with or reacting to trauma-related field work experiences and course content] and perceptions of stress in field and coursework) and protective factors (SC effort and importance) in relation to burnout (BO), health status (HS), secondary traumatic stress symptoms (STSS), and compassion satisfaction (CS) among 195 students in a graduate social work training program. Results: All students reported trauma exposures in their field placements and/or coursework, including retraumatization experiences that were associated with higher STSS and BO. Field stress and SC effort were both consistent predictors across outcomes. Higher field stress levels predicted higher BO and STSS, a greater likelihood of decline in HS, and lower CS. Lower SC effort was also associated with higher BO and STSS, and a greater likelihood of decline in HS, while higher SC effort predicted higher CS. Older students, those with traumatized field clients, and those whose field work addressed trauma, also reported higher CS. Conclusions: These findings suggest that clinical training involving trauma content can be both rewarding and stressful, and may evoke distress in some trainees. Given that learning about and working with trauma are essential to adequate clinical training, the authors suggest adopting a trauma-informed approach within clinical training programs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Reduced Trauma Symptoms and Perceived Stress in Male Prison Inmates through the Transcendental Meditation Program: A Randomized Controlled Trial.

PubMed

Nidich, Sanford; O'connor, Tom; Rutledge, Thomas; Duncan, Jeff; Compton, Blaze; Seng, Angela; Nidich, Randi

2016-01-01

Trauma events are four times more prevalent in inmates than in the general public and are associated with increased recidivism and other mental and physical health issues. To evaluate the effects of Transcendental Meditation (TM) on trauma symptoms in male inmates. One hundred eighty-one inmates with a moderate- to high-risk criminal profile were randomly assigned to either the TM program or to a usual care control group. The Trauma Symptom Checklist and the Perceived Stress Scale were administered at baseline and four-month posttest. Significant reductions in total trauma symptoms, anxiety, depression, dissociation, and sleep disturbance subscales, and perceived stress in the TM group were found compared with controls (all p values < 0.001). The high-trauma subgroup analysis further showed a higher magnitude of effects in the TM group compared with controls on all outcomes, with Cohen effect sizes ranging from 0.67 to 0.89. Results are consistent with those of prior studies of the TM program in other populations and its effects on trauma symptoms and perceived stress.

General surgery resident rotations in surgical critical care, trauma, and burns: what is optimal for residency training?

PubMed

Napolitano, Lena M; Biester, Thomas W; Jurkovich, Gregory J; Buyske, Jo; Malangoni, Mark A; Lewis, Frank R

2016-10-01

There are no specific Accreditation Council for Graduate Medical Education General Surgery Residency Program Requirements for rotations in surgical critical care (SCC), trauma, and burn. We sought to determine the experience of general surgery residents in SCC, trauma, and burn rotations. Data analysis of surgical rotations of American Board of Surgery general surgery resident applicants (n = 7,299) for the last 8 years (2006 to 2013, inclusive) was performed through electronic applications to the American Board of Surgery Qualifying Examination. Duration (months) spent in SCC, trauma, and burn rotations, and postgraduate year (PGY) level were examined. The total months in SCC, trauma and burn rotations was mean 10.2 and median 10.0 (SD 3.9 months), representing approximately 16.7% (10 of 60 months) of a general surgery resident's training. However, there was great variability (range 0 to 29 months). SCC rotation duration was mean 3.1 and median 3.0 months (SD 2, min to max: 0 to 15), trauma rotation duration was mean 6.3 and median 6.0 months (SD 3.5, min to max: 0 to 24), and burn rotation duration was mean 0.8 and median 1.0 months (SD 1.0, min to max: 0 to 6). Of the total mean 10.2 months duration, the longest exposure was 2 months as PGY-1, 3.4 months as PGY-2, 1.9 months as PGY-3, 2.2 months as PGY-4 and 1.1 months as PGY-5. PGY-5 residents spent a mean of 1 month in SCC, trauma, and burn rotations. PGY-4/5 residents spent the majority of this total time in trauma rotations, whereas junior residents (PGY-1 to 3) in SCC and trauma rotations. There is significant variability in total duration of SCC, trauma, and burn rotations and PGY level in US general surgery residency programs, which may result in significant variability in the fund of knowledge and clinical experience of the trainee completing general surgery residency training. As acute care surgery programs have begun to integrate emergency general surgery with SCC, trauma, and burn rotations, it is an ideal time to determine the optimal curriculum and duration of these important rotations for general surgery residency training. Copyright © 2016 Elsevier Inc. All rights reserved.

Leadership and Teamwork in Trauma and Resuscitation

PubMed Central

Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

2016-01-01

Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance. Conclusion Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership’s effect on patient-level outcome. PMID:27625718

Exploring Nurses’ Knowledge and Experiences Related to Trauma-Informed Care

PubMed Central

Stokes, Yehudis; Jacob, Jean-Daniel; Gifford, Wendy; Squires, Janet; Vandyk, Amanda

2017-01-01

Trauma-informed care is an emerging concept that acknowledges the lasting effects of trauma. Nurses are uniquely positioned to play an integral role in the advancement of trauma-informed care. However, knowledge related to trauma-informed care in nursing practice remains limited. The purpose of this article is to present the results of a qualitative study which explored nurses’ understandings and experiences related to trauma-informed care. Seven semistructured interviews were conducted with nurses and four categories emerged from the analysis: (a) Conceptualizing Trauma and Trauma-Informed Care, (b) Nursing Care and Trauma, (c) Context of Trauma-Informed Care, and (d) Dynamics of the Nurse–Patient Relationship in the Face of Trauma. These findings highlight important considerations for trauma-informed care including the complex dynamics of trauma that affect care, the need to push knowledge about trauma beyond mental health care, and noteworthy parallels between nursing care and trauma-informed care. PMID:29085862

Exploring Nurses' Knowledge and Experiences Related to Trauma-Informed Care.

PubMed

Stokes, Yehudis; Jacob, Jean-Daniel; Gifford, Wendy; Squires, Janet; Vandyk, Amanda

2017-01-01

Trauma-informed care is an emerging concept that acknowledges the lasting effects of trauma. Nurses are uniquely positioned to play an integral role in the advancement of trauma-informed care. However, knowledge related to trauma-informed care in nursing practice remains limited. The purpose of this article is to present the results of a qualitative study which explored nurses' understandings and experiences related to trauma-informed care. Seven semistructured interviews were conducted with nurses and four categories emerged from the analysis: (a) Conceptualizing Trauma and Trauma-Informed Care, (b) Nursing Care and Trauma, (c) Context of Trauma-Informed Care, and (d) Dynamics of the Nurse-Patient Relationship in the Face of Trauma. These findings highlight important considerations for trauma-informed care including the complex dynamics of trauma that affect care, the need to push knowledge about trauma beyond mental health care, and noteworthy parallels between nursing care and trauma-informed care.

Training dedicated emergency physicians in surgical critical care: knowledge acquisition and workforce collaboration for the care of critically ill trauma/surgical patients.

PubMed

Chiu, William C; Marcolini, Evie G; Simmons, Dell E; Yeatts, Dale J; Scalea, Thomas M

2011-07-01

The Leapfrog Group initiative has led to an increasing public demand for dedicated intensivists providing critical care services. The Acute Care Surgery training initiative promotes an expansion of trauma/surgical care and operative domain, redirecting some of our focus from critical care. Will we be able to train and enforce enough intensivists to care for critically ill surgical patients? We have been training emergency physicians (EPs) alongside surgeons in our country's largest Trauma/Surgical Critical Care Fellowship Program annually for more than a decade. We reviewed our Society of Critical Care Medicine Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP, critical care in-training examination) scores from 2006 to 2009 (4 years). The MCCKAP, administered during the ninth month of a Critical Care Fellowship, is the only known standardized objective examination available in this country to compare critical care knowledge acquisition across different specialties. Subsequent workforce outcome for these Emergency Medicine Critical Care Fellowship graduates was analyzed. Over the 4-year period, we trained 42 Fellows in our Program who qualified for this study (30 surgeons and 12 EPs). Surgeons and EP performance scores on the MCCKAP examination were not different. The mean National Board Equivalent score was 419 ± 61 (mean ± standard deviation) for surgeons and 489 ± 87 for EPs. The highest score was achieved by an EP. The lowest score was not achieved by an EP. Ten of 12 (83%) EP Critical Care Fellowship graduates are practicing inpatient critical care in intensive care units with attending physician level responsibilities. EPs training in a Surgical Critical Care Fellowship can acquire critical care knowledge equivalent to that of surgeons. EPs trained in a Surgical Critical Care paradigm can potentially expand the intensive care unit workforce for Surgical Critical Care patients.

A Program for Clinical Care in Physical Trauma--Combat Surgery and Bioengineering.

DTIC Science & Technology

and energy exchange; Bone composition and fractures; Computer technology in intensive care; Manitol toxicity; Liver blood flow transplantation; Infections and immunology--Candida infection and Pseudomonas immunity. (Author)

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers

PubMed Central

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M.; Karanikas, Alexia T.; Oyeniyi, Blessing; Holcomb, John B.; Cap, Andrew P.; Rasmussen, Todd E.

2015-01-01

ABSTRACT Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military–civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a “state of the science” review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients. PMID:26428845

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers.

PubMed

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M; Karanikas, Alexia T; Oyeniyi, Blessing; Holcomb, John B; Cap, Andrew P; Rasmussen, Todd E

2015-12-01

Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military-civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a "state of the science" review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients.

[Early interdisciplinary geriatric rehabilitation after hip fracture : Effective concept or just transfer of costs?].

PubMed

Lögters, T; Hakimi, M; Linhart, W; Kaiser, T; Briem, D; Rueger, J; Windolf, J

2008-09-01

Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion. This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86+/-8 (65-110) years. All patients were treated operatively. After a mean of 12+/-9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27+/-13 (4-103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index. With discharge from the acute care hospital, the Barthel index was 42+/-20 points and it increased during rehabilitation to 65+/-26 points. One year later the Barthel index was 67+/-28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75+/-24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52+/-27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome. Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.

Insuring the uninsured: potential impact of Health Care Reform Act of 2010 on trauma centers.

PubMed

Shafi, Shahid; Ogola, Gerald; Fleming, Neil; Rayan, Nadine; Kudyakov, Rustam; Barnes, Sunni A; Ballard, David J

2012-11-01

Viability of trauma centers is threatened by cost of care provided to patients without health insurance. The health care reform of 2010 is likely to benefit trauma centers by mandating universal health insurance by 2014. However, the financial benefit of this mandate will depend on the reimbursement provided. The study hypothesis was that compensation for the care of uninsured trauma patients at Medicare or Medicaid rates will lead to continuing losses for trauma centers. Financial data for first hospitalization were obtained from an urban Level I trauma center for 3 years (n = 6,630; 2006-2008) and linked with clinical information. Patients were grouped into five payments categories: commercial (29%), Medicaid (8%), Medicare (20%), workers' compensation (6%), and uninsured (37%). Prediction models for costs and payments were developed for each category using multiple regression models, adjusting for patient demographics, injury characteristics, complications, and survival. These models were used to predict payments that could be expected if uninsured patients were covered by different insurance types. Results are reported as net margin per patient (payments minus total costs) for each insurance type, with 95% confidence intervals, discounted to 2008 dollar values. Patients were typical for an urban trauma center (median age of 43 years, 66% men, 82% blunt, 5% mortality, and median length of stay 4 days). Overall, the trauma center lost $5,655 per patient, totaling $37.5 million over 3 years. These losses were encountered for patients without insurance ($14,343), Medicare ($4,838), and Medicaid ($15,740). Patients with commercial insurance were profitable ($5,295) as were those with workers' compensation ($6,860). Payments for the care of the uninsured at Medicare/Medicaid levels would lead to continued losses at $2,267 to $4,143 per patient. The health care reforms of 2010 would lead to continued losses for trauma centers if uninsured are covered with Medicare/Medicaid-type programs. Economic analysis, level II.

Implementation and Evaluation of a Ward-Based eLearning Program for Trauma Patient Management.

PubMed

Curtis, Kate; Wiseman, Taneal; Kennedy, Belinda; Kourouche, Sarah; Goldsmith, Helen

2016-01-01

The majority of trauma nursing education is focused on the emergency phases of care. We describe the development and evaluation of a trauma eLearning module for the ward environment. The module was developed using adult learning principles and implemented in 2 surgical wards. There were 3 phases of evaluation: (1) self-efficacy of nurses; (2) relevance and usability of the module and; (3) application of knowledge learnt. The majority indicated they had applied new knowledge, particularly when performing a physical assessment (85.7%), communicating (91.4%), and identifying risk of serious illness (90.4%). Self-efficacy relating to confidence in caring for patients, communication, and escalating clinical deterioration improved (p = .023). An eLearning trauma patient assessment module for ward nursing staff improves nursing knowledge and self-efficacy.

Teamwork education improves trauma team performance in undergraduate health professional students.

PubMed

Baker, Valerie O'Toole; Cuzzola, Ronald; Knox, Carolyn; Liotta, Cynthia; Cornfield, Charles S; Tarkowski, Robert D; Masters, Carolynn; McCarthy, Michael; Sturdivant, Suzanne; Carlson, Jestin N

2015-01-01

Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team's ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively) as measured by TEAM. Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.

Changes in Pulse Character and Mental Status are Late Responses to Central Hypovolemia

DTIC Science & Technology

2008-06-01

central hypovolemia 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Ryan K. L., Batchinsky A. I., McManus J . G...Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185–193. 2... J Trauma. 1996;40:S165–S169. 4. Champion H, Sacco W, Carnazzo A, Copes W, Fouty W: Trauma score. Crit Care Med. 1981;9:672–676. 5. Meredith W

Making strides towards better mental health care in Peru: Results from a primary care mental health training

PubMed Central

Borba, C. P.C.; Gelaye, B.; Zayas, L.; Ulloa, M.; Lavelle, J.; Mollica, R.F.; Henderson, D.C.

2015-01-01

Our program attempted to improve attitudes and confidence of Peruvian primary care physicians (PCPs) providing mental health care. The training program underwent an evaluation to determine impact of sustained confidence in performing medical and psychiatric procedures, and application of learned skills. Fifty-two Peruvian primary care practitioners were trained at the Harvard Program in Refugee Trauma (HPRT) over a two-week period. There was significant improvement in PCPs’ confidence levels of performing psychiatric procedures (counseling, prescribing medications, psychiatric diagnosis, assessing the risk for violence, and treating trauma victims) when comparing baseline and post-two-week to one year follow-up. When comparing post-two-week and one-year follow-up quantitative measures, confidences levels went slightly down. This may be an implication that the frequency of trainings and supervisions are needed more frequently. In contrast, qualitative responses from the one-year follow-up revealed increase in victims of violence clinical care, advocacy, awareness, education, training, policy changes, accessibility of care, and sustainment of diagnostic tools. This study supports the feasibility of training PCP's in a culturally effective manner with sustainability over time. PMID:27054141

Pitfalls of implementing acute care surgery.

PubMed

Kaplan, Lewis J; Frankel, Heidi; Davis, Kimberly A; Barie, Philip S

2007-05-01

Incorporating emergency general surgery into the current practice of the trauma and critical care surgeon carries sweeping implications for future practice and training. Herein, we examine the known benefits of the practice of emergency general surgery, contrast it with the emerging paradigm of acute care surgery, and examine pitfalls already encountered in integration of emergency general surgery into a traditional trauma/critical care surgery service. A MEDLINE literature search was supplemented with local experience and national presentations at major meetings to provide data for this review. Considerations including faculty complement, service structure, resident staffing, physician extenders, the decreased role of community hospitals in providing trauma and emergency general surgery care, and the effects on an elective operative schedule are inadequately explored at present. There are no firm recommendations as to how to incorporate emergency general surgery into a trauma/critical care practice that will satisfy both academic and community practice paradigms. The near future seems likely to embrace the expanded training and clinical care program termed acute care surgery. A host of essential elements have yet to be examined to undertake a critical analysis of the applicability, advisability, and appropriate structure of both emergency general surgery and acute care surgery in the United States. Proceeding along this pathway may be fraught with training, education, and implementation pitfalls that are ideally addressed before deploying acute care surgery as a national standard.

Implementation of the trauma registry as a tool for quality improvement in trauma care in a brazilian hospital: the first 12 months.

PubMed

Parreira, José Gustavo; de Campos, Tércio; Perlingeiro, Jacqueline A Gianinni; Soldá, Silvia C; Assef, José Cesar; Gonçalves, Augusto Canton; Zuffo, Bruno Malteze; Floriano, Caio Gomes; de Oliveira, Erik Haruk; de Oliveira, Renato Vieira Rodrigues; Oliveira, Amanda Lima; de Melo, Caio Gullo; Below, Cristiano; Miranda, Dino R Pérez; Santos, Gabriella Colasuonno; de Almeida, Gabriele Madeira; Brianti, Isabela Campos; Votto, Karina Baruel de Camargo; Schues, Patrick Alexander Sauer; dos Santos, Rafael Gomes; de Figueredo, Sérgio Mazzola Poli; de Araujo, Tatiani Gonçalves; Santos, Bruna do Nascimento; Ferreira, Laura Cardoso Manduca; Tanaka, Giuliana Olivi; Matos, Thiara; da Sousa, Maria Daiana; Augusto, Samara de Souza

2015-01-01

to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS), and its ability to identify points for improvement in the quality of care provided. the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1) or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT) software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process. data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI. the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.

Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

PubMed

Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

2016-09-01

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.

A Yoga Intervention Program for Patients Suffering from Symptoms of Posttraumatic Stress Disorder: A Qualitative Descriptive Study.

PubMed

Jindani, Farah A; Khalsa, G F S

2015-07-01

To understand how individuals with symptoms of posttraumatic stress disorder (PTSD) perceive a trauma-sensitive Kundalini yoga (KY) program. Digitally recorded telephone interviews 30-60 minutes in duration were conducted with 40 individuals with PTSD participating in an 8-week KY treatment program. Interviews were transcribed verbatim and analyzed using qualitative thematic analysis techniques. Qualitative analysis identifies three major themes: self-observed changes, new awareness, and the yoga program itself. Findings suggest that participants noted changes in areas of health and well-being, lifestyle, psychosocial integration, and perceptions of self in relation to the world. Presented are practical suggestions for trauma-related programming. There is a need to consider alternative and potentially empowering approaches to trauma treatment. Yoga-related self-care or self-management strategies are widely accessible, are empowering, and may address the mind-body elements of PTSD.

Leverage front-line expertise to maximize trauma prevention efforts.

PubMed

2012-06-01

The trauma prevention program at Geisinger Wyoming Valley (GWV) Medical Center in Wilkes-Barre, PA, has enlisted the assistance of an experienced paramedic and ED tech to spend part of his time targeting prevention education toward populations that have been experiencing high rates of traumatic injuries. While community outreach has long been a priority for the trauma prevention program, the new position is enabling GWV to boost the magnitude of its prevention efforts, and to reach out to referring facilities as well. Program administrators say a similar outreach effort aimed at EMS providers has strengthened relationships and helped to improve trauma care at the facility. The new trauma injury prevention outreach coordinator has focused his first efforts on fall prevention and curbing motor vehicle accidents among very young and very mature driving populations. Data from GWV's trauma registry suggest that its fall prevention efforts are having an effect. The incidence of falls among patients over the age 65 is down by about 10% at the facility since it began targeting education at the community's senior population. Administrators say a monthly lecture series aimed at the prehospital community has gone a long way toward nurturing ties with EMS providers. Called "EMS Night Out," the series covers a range of topics, but the most popular programs involve case reviews.

The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations.

PubMed

Sheff, Alex; Park, Elyse R; Neagle, Mary; Oreskovic, Nicolas M

2017-07-25

Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination. We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA. Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs. Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.

Understanding the burden and outcome of trauma care drives a new trauma systems model.

PubMed

Laing, G L; Skinner, D L; Bruce, J L; Aldous, C; Oosthuizen, G V; Clarke, D L

2014-07-01

The Pietermaritzburg Metropolitan Trauma Service (PMTS) attempts to provide care for a whole city and hence is referred to as a service rather than a center. As part of a multifaceted quality improvement program, the PMTS has developed and implemented a robust electronic surgical registry (ESR). This review of the first year's data from the ESR forms part of a situational analysis to assess the burden of trauma managed by the service and the quality of care delivered within the constraints of the available resources. Formal ethical approval was obtained prior to design and development of this study, and appropriate commercial software was sourced. The exercise of data capture was integrated into the process of service delivery and was accomplished at the endpoint of patient care. 12 months after implementation of the registry, the data were extracted and audited. A total of 2,733 patients were admitted over the 12 month study period. The average patient age was 28.3 years. There were 2,255 (82.5 %) male patients and 478 (17.5 %) female patients. The average monthly admission rate was 228 patients, with a peak of 354 admissions over the December period. The mean injury severity score (ISS) was 12 [interquartile range (IQR) 6.7-23.2]. A quarter (24.8 %) of all new emergency admissions had an ISS > 15. The average duration of stay for patients was 5.12 days (IQR 2.3-13.2 days). Some 2,432 (92.1 %) patients survived, and 208 (7.9 %) died. A total of 333 (13 %) patients required admission to either the intensive care unit (ICU) or the high dependency unit. From the city mortuary data a further 362 deaths were identified. These included 290 deaths that occurred on scene and 72 that occurred within Pietermaritzburg hospitals other than Greys and Edendale. The total trauma-related mortality for the entire city in 2012 was 570 (51 % on-scene deaths and 49 % in-hospital deaths). Blunt trauma accounted for 62 % of deaths. The PMTS treats a significant volume and spectrum of trauma. Despite significant resource limitations, we have managed to implement a functional and sustainable trauma service across multiple hospitals. We believe the major resource deficits limiting our service could be ameliorated by the development of an additional trauma facility, adequately equipped with dedicated trauma operating slates and trauma ICU beds. The adoption of our current model of trauma care came out of a need to work within our resource constraints, and it differs from the traditional model. Within the aforementioned limits, our data suggest that this model of delivering care is feasible, practical, and successful. Considering the universal burden of trauma and the all-too-common imbalance between resource demand and supply among many health-care institutions, it is our hope that this report will contribute to the ongoing academic debate around the topic of optimal systems of providing global trauma care.

Compassion Fatigue in the Military Caregiver

DTIC Science & Technology

2009-03-01

Compassion Fatigue/ Burnout Syndrome Figley, C (1995; 97)19 Sprang, Clark, and Whitt-Woosley in their article, “Compassion Fatigue, Compassion...alternative or additional programs, process or intervention to address compassion fatigue, burnout , stress disorder or other debilitating post-traumatic...effects. 15. SUBJECT TERMS Caregiver, Care Provider, Secondary Traumatic Stress, Combat Trauma, Shared Trauma, Posttraumatic Stress Disorder, Burnout 16

Domestic Trauma and Adult Education on the United States-Mexico Border

ERIC Educational Resources Information Center

Muro, Andres; Mein, Erika

2010-01-01

While there are increasing efforts to address the problem of domestic violence and trauma in the justice, health care, and social service systems, the adult education system still lags behind. The inattention to this issue in adult education is particularly troubling because these programs often play a significant role in the lives of women who…

The influence of a Vascular Surgery Hospitalist program on physician and patient satisfaction, resident education, and resource utilization.

PubMed

Cull, David L; Langan, Eugene M; Taylor, Spence M; Carsten, Christopher G; Tong, Angie; Johnson, Brent

2013-10-01

A number of surgery practice models have been developed to address general and trauma surgeon workforce shortages and on-call issues and to improve surgeon satisfaction. These include the creation of acute or urgent care surgery services and "surgical hospitalist" programs. To date, no practice models corresponding to those developed for general and trauma surgeons have been proposed to address these same issues among vascular surgeons or other surgical subspecialists. In 2003, our practice established a Vascular Surgery Hospitalist program. Since its inception nearly a decade ago, it has undergone several modifications. We reviewed hospital administrative databases and surveys of faculty, residents, and patients to evaluate the program's impact. Benefits of the Vascular Surgery Hospitalist program include improved surgeon satisfaction, resource utilization, timeliness of patient care, communication among referring physicians and ancillary staff, and resident teaching/supervision. Elements of this program may be applicable to a variety of surgical subspecialty settings. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Who will cover the cost of undocumented immigrant trauma care?

PubMed

Mitchell, Christopher D; Truitt, Michael S; Shifflette, Vanessa K; Johnson, Van; Mangram, Alicia J; Dunn, Ernest L

2012-03-01

Health care reform under the "Patient Protection and Affordable Care Act" (PPACA) will lead to changes in reimbursement. Although this legislation provides a mechanism for uninsured Americans to obtain coverage, it excludes undocumented immigrants (UDI). Reimbursement for UDIs comes from the disproportionate share hospital (DSH) program and was previously supported by Section-1011 of the 2003 Medicare Modernization Act (S1011). The PPACA details a cut of DSH funds starting in 2014. This could impose a significant financial burden on trauma centers. From May 2005 to May 2008, we retrospectively reviewed all trauma-related emergency room visits by UDIs. We quantified charges for three entities: emergency department physicians, trauma surgeons, and the hospital. We applied our average institutional collection rate to these charges and compared these projected collections with the actual collections. Over a three-year period, we identified 1,325 trauma UDIs. The financial records revealed a projected emergency department physicians collection of $452,686, a projected trauma surgeons collection of $1.2 million, and a projected hospital collection of $6.9 million (total $8.6 million). Actual funding from S1011 provided $1.7 million and DSH provided $1.9 million (total $3.6 million). Texas State Funding and UDI self-payment contributed $611,082. Overall, our institution had a reimbursement discrepancy of $4.3 million with DSH/S1011 assistance. This increased to $6.0 million after the termination of S1011 and may increase to $7.9 million under PPACA. These figures underestimate the total cost of UDI trauma care as it only includes three entities. Our data represent a fraction of national figures. Failure to address these issues could result in ongoing financial problems for trauma centers. II, economic and decision analysis.

Handling Kids in Crisis with Care

ERIC Educational Resources Information Center

Bushinski, Cari

2018-01-01

The Handle with Care program helps schools help students who experience trauma. While at the scene of an event like a domestic violence call, drug raid, or car accident, law enforcement personnel determine the names and school of any children present. They notify that child's school to "handle ___ with care" the next day, and the school…

Stigma, American military personnel and mental health care: challenges from Iraq and Afghanistan.

PubMed

Schreiber, Michael; McEnany, Geoffry Phillips

2015-02-01

Since 2001, more than 2.5 million United States military personnel have been deployed for combat. Over one million have served multiple deployments. Combat generally involved repeated exposure to highly traumatic events. Personnel were also victims of military sexual trauma (MST), a major risk factor for psychiatric illness. Most survivors do not seek or receive mental health care. Stigma is one of the main barriers to that care. To explore the impact of stigma on personnel with psychiatric illness, and suggest some innovative ways to potentially reduce stigma and improve care. Cinahl and PubMed databases were searched from 2001 to 2014. Anonymity, the use of non-stigmatizing language, peer-to-peer, and stigma-reduction programs help military personnel receive mental health care. Technology offers the opportunity for effective and appropriate education and treatment. Although stigma is formidable, several innovative services are available or being developed for military victims of trauma. Commitment of resources for program development and further research to explore which interventions offer the best clinical outcomes are needed to increase efforts to combat stigma and ensure quality care.

Where There is No EMS: Lay Providers in Emergency Medical Services Care - EMS as a Public Health Priority.

PubMed

Debenham, Sierra; Fuller, Matthew; Stewart, Matthew; Price, Raymond R

2017-12-01

By 2030, road traffic accidents are projected to be the fifth leading cause of death worldwide, with 90% of these deaths occurring in low- and middle-income countries (LMICs). While high-quality, prehospital trauma care is crucial to reduce the number of trauma-related deaths, effective Emergency Medical Systems (EMS) are limited or absent in many LMICs. Although lay providers have long been recognized as the front lines of informal trauma care in countries without formal EMS, few efforts have been made to capitalize on these networks. We suggest that lay providers can become a strong foundation for nascent EMS through a four-fold approach: strengthening and expanding existing lay provider training programs; incentivizing lay providers; strengthening locally available first aid supply chains; and using technology to link lay provider networks. Debenham S , Fuller M , Stewart M , Price RR . Where there is no EMS: lay providers in Emergency Medical Services care - EMS as a public health priority. Prehosp Disaster Med. 2017;32(6):593-595.

A critical care helicopter system in trauma.

PubMed Central

Jacobs, L. M.; Bennett, B.

1989-01-01

Civilian helicopters and emergency medical services in the United States have been in existence for approximately 15 years. The rapid growth of this type of health care delivery coupled with an increasing number of accidents has prompted professional and lay scrutiny of these programs. Although they have a demonstrated history of benefit to patients, the type and severity of injuries to patients who are eligible for helicopter transportation need further definition. The composition of the medical crews and the benefits that particular crew members bring to the patients require ongoing evaluation. Significant questions regarding the number of pilots in a helicopter and in a program remain to be answered. This article reviews the role of emergency medical air transport services in providing care to trauma patients, staff training and evaluation, and safety criteria and offers recommendations to minimize risks to patients and crews. PMID:2695653

The Veterans Health Administration and military sexual trauma.

PubMed

Kimerling, Rachel; Gima, Kristian; Smith, Mark W; Street, Amy; Frayne, Susan

2007-12-01

We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. We analyzed VHA administrative data for 185,880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women's health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.

The Veterans Health Administration and Military Sexual Trauma

PubMed Central

Kimerling, Rachel; Gima, Kristian; Smith, Mark W.; Street, Amy; Frayne, Susan

2007-01-01

Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women’s health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans. PMID:17971558

Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study.

PubMed

Clark, Diane E; Lowman, John D; Griffin, Russell L; Matthews, Helen M; Reiff, Donald A

2013-02-01

Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS). The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU). This was a retrospective cohort study of an interdisciplinary quality-improvement program. Pre- and post-early mobility program patient data from the trauma registry for 2,176 patients admitted to the TBICU between May 2008 and April 2010 were compared. No adverse events were reported related to the early mobility program. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and deep vein thrombosis) post-early mobility program. Ventilator days and TBICU and hospital lengths of stay were not significantly decreased. Using a historical control group, there was no way to account for other changes in patient care that may have occurred between the 2 periods that could have affected patient outcomes. The dose of physical activity both before and after the early mobility program were not specifically assessed. Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU.

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa.

PubMed

Watt, Melissa H; Dennis, Alexis C; Choi, Karmel W; Ciya, Nonceba; Joska, John A; Robertson, Corne; Sikkema, Kathleen J

2017-11-01

South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.

Trauma quality improvement in low and middle income countries of the Asia-Pacific region: a mixed methods study.

PubMed

Stelfox, Henry Thomas; Joshipura, Manjul; Chadbunchachai, Witaya; Ellawala, Ranjith N; O'Reilly, Gerard; Nguyen, Thai Son; Gruen, Russell L

2012-08-01

Quality Improvement (QI) programs have been shown to be a valuable tool to strengthen care of severely injured patients, but little is known about them in low and middle income countries (LMIC). We sought to explore opportunities to improve trauma QI activities in LMIC, focusing on the Asia-Pacific region. We performed a mixed methods research study using both inductive thematic analysis of a meeting convened at the Royal Australasian College of Surgeons, Melbourne, Australia, November 21-22, 2010 and a pre-meeting survey to explore experiences with trauma QI activities in LMIC. Purposive sampling was employed to invite participants with demonstrated leadership in trauma care to provide diverse representation of organizations and countries within Asia-Pacific. A total of 22 experts participated in the meeting and reported that trauma QI activities varied between countries and organizations: morbidity and mortality conferences (56 %), monitoring complications (31 %), preventable death studies (25 %), audit filters (19 %), and statistical methods for analyzing morbidity and mortality (6 %). Participants identified QI gaps to include paucity of reliable/valid injury data, lack of integrated trauma QI activities, absence of standards of care, lack of training in QI methods, and varying cultures of quality and safety. The group highlighted barriers to QI: limited engagement of leaders, organizational diversity, limited resources, heavy clinical workload, and medico-legal concerns. Participants proposed establishing the Asia-Pacific Trauma Quality Improvement Network (APTQIN) as a tool to facilitate training and dissemination of QI methods, injury data management, development of pilot QI projects, and advocacy for quality trauma care. Our study provides the first description of trauma QI practices, gaps in existing practices, and barriers to QI in LMIC of the Asia-Pacific region. In this study we identified opportunities for addressing these challenges, and that work will be supported by APTQIN.

[Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

PubMed

Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

2010-08-01

There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

Assessment of trauma quality improvement activities at public hospitals in Thailand.

PubMed

Fuangworawong, Phuphit; LaGrone, Lacey N; Chadbunchachai, Witaya; Sornsrivichai, Vorasith; Mock, Charles N; Vavilala, Monica S

2016-09-01

Given the current exceptional burden of injury in Thailand, the proven efficacy of quality improvement programs, and the current scarcity of national-level information on trauma quality improvement program (TQIP) implementation in Thailand, we aimed to examine the use of TQIPs and barriers to TQIP adoption in Thai public trauma centers. We distributed a survey to 110 public hospitals which are designated to provide trauma care in Thailand. The survey assessed the presence or absence of the four core elements of the World Health Organization (WHO) recommended TQIPs (morbidity and mortality (M&M) conferences, preventable death panels, trauma registries, and audit filters), and provider perception of barriers and priorities in TQIP implementation. Responses were received from 80 (72%) respondents. Seventy-two (90%) reported having a trauma registry and seventy (88%) respondents reported use of audit filters. Seventy (88%) respondents reported conducting regular M&M conferences, and 45 (56%) respondents reported the presence of preventable death panels. Thirty-eight (48%) respondents reported presence of all four elements of WHO TQIPs. The most commonly reported barriers to implementing TQIPs were lack of interest (55; 68%) and lack of time (39; 48%)to implement TQIPs. Audit filters were reported by only 25 (31%) of respondents and optimization of audit filters was the most frequently identified next-step in further development of TQIP. Just under half of responding Thai public trauma centers reported implementation of all four elements of the WHO recommended TQIPs. Priority strategies to facilitate TQIP maturation in Thailand should address staff motivation, provision of staff time for TQIP development, and optimization of audit filter use to monitor quality of care. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care".

PubMed

Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

2012-10-01

Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization's Guidelines for Essential Trauma Care. All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on "Guidelines for Essential Trauma Care" and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection. Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited. This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.

Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients.

PubMed

Murphy, Margaret; Curtis, Kate; Lam, Mary K; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea

2018-05-01

Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p < 0.001) and had a higher incidence of falls and assaults (p < 0.001). There was a reduction in time to critical operation, from 2.63 h (IQR 1.23-5.12) in the PRE-group to 0.55 h (IQR 0.22-1.27) in the POST-group, p < 0.001. The overall ED LOS increased, and there was no reduction in mortality. Post-hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001. The implementation of trauma team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. Retrospective comparative therapeutic/care management study, Level III evidence. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

77 FR 45421 - Homeless Emergency Assistance and Rapid Transition to Housing: Continuum of Care Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-31

... Re-Housing for Families Demonstration program and the Homelessness Prevention and Rapid Re-Housing... to quickly rehouse homeless individuals and families while minimizing the trauma and dislocation caused to homeless individuals, families, and communities by homelessness; promote access to and...

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims.

PubMed

Melhorn, J M

1999-02-01

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.

Post-Traumatic Stress Disorder Among Health Care Providers Following the Israeli Attacks Against Gaza Strip in 2014: A Call for Immediate Policy Actions.

PubMed

Abu-El-Noor, Nasser Ibrahim; Aljeesh, Yousef Ibrahim; Radwan, AbdalKarim Said; Abu-El-Noor, Mysoon Khalil; Qddura, Ibrahim Abdel-Ilhady; Khadoura, Khalid Jamal; Alnawajha, Samer Khader

2016-04-01

This study aimed to assess the level of posttraumatic stress disorder and to examine the relationship between exposure to war stress and posttraumatic symptoms among health care providers following Israeli offensives against Gaza Strip in 2014. A cross-sectional design was used for this study. We targeted all nurses and doctors working in three governmental hospitals in the Gaza Strip and worked with victims of the last war, more specifically, those who were working in emergency departments, intensive care units, operating rooms, surgical departments, and burn units. A demographic sheet and Impact Event Scale-Revised were used in this study. The Impact Event Scale-Revised has three sub-scales; intrusion, avoidance, and hyper-arousal. The results showed that 291 (89.8%) of 324 participants had scores more than 35 (threshold cut-off point) on the Impact Event Scale-Revised. Scores ranged from zero to 80 with a mean of 52.13. Females had higher levels of stress (55.79) than males (51.63) and nurses (54.85) had more stress than physicians (47.38). The most frequent symptoms of trauma subscales was "avoidance" (mean=20.04), followed by "intrusion" (mean=17.83), and then "hyper-arousal" (mean=14.27). Levels of trauma symptoms were not affected by place of living, hospital of work, while level of education had impacted level of trauma. The findings showed that health care providers suffered from severe posttraumatic symptoms after exposure to prolonged war stress. This level of trauma among health care providers warrants intervention programs to reduce stress and trauma among Gaza health care providers after the war. Copyright © 2015 Elsevier Inc. All rights reserved.

Child-Adult Relationship Enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges.

PubMed

Gurwitch, Robin H; Messer, Erica Pearl; Masse, Joshua; Olafson, Erna; Boat, Barbara W; Putnam, Frank W

2016-03-01

Child maltreatment impacts approximately two million children each year, with physical abuse and neglect the most common form of maltreatment. These children are at risk for mental and physical health concerns and the ability to form positive social relationships is also adversely affected. Child Adult Relationship Enhancement (CARE) is a set of skills designed to improve interactions of any adult and child or adolescent. Based on parent training programs, including the strong evidence-based treatment, Parent-Child Interaction Therapy (PCIT), CARE was initially developed to fill an important gap in mental health services for children of any age who are considered at-risk for maltreatment or other problems. CARE subsequently has been extended for use by adults who interact with children and youth outside of existing mental health therapeutic services as well as to compliment other services the child or adolescent may be receiving. Developed through discussions with Parent-Child Interaction Therapy (PCIT) therapists and requests for a training similar to PCIT for the non-mental health professional, CARE is not therapy, but is comprised of a set of skills that can support other services provided to families. Since 2006, over 2000 caregivers, mental health, child welfare, educators, and other professionals have received CARE training with a focus on children who are exposed to trauma and maltreatment. This article presents implementation successes and challenges of a trauma-informed training designed to help adults connect and enhance their relationships with children considered at-risk. Copyright © 2015 Elsevier Ltd. All rights reserved.

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

PubMed

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

PubMed

Noffsinger, Dana L

2014-01-01

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Evaluation of Resources Necessary for Provision of Trauma Care in Botswana: An Initiative for a Local System.

PubMed

Mwandri, Michael B; Hardcastle, Timothy C

2018-06-01

Developing countries face the highest incidence of trauma, and on the other hand, they do not have resources for mitigating the scourge of these injuries. The World Health Organization through the Essential Trauma Care (ETC) project provides recommendations for improving management of the injured and building up of systems that are effective in low-middle-income countries (LMICs). This study uses ETC project recommendations and other trauma-care guidelines to evaluate the current status of the resources and organizational structures necessary for optimal trauma care in Botswana; an African country with relatively good health facilities network, subsidized public hospital care and a functioning Motor Vehicle Accident fund covering road traffic collision victims. A cross-sectional descriptive design employed convenience sampling for recruiting high-volume trauma hospitals and selecting candidates. A questionnaire, checklist, and physical verification of resources were utilized to evaluate resources, staff knowledge, and organization-of-care and hospital capabilities. Results are provided in plain descriptive language to demonstrate the findings. Necessary consumables, good infrastructure, adequate numbers of personnel and rehabilitation services were identified all meeting or exceeding ETC recommendations. Deficiencies were noted in staff knowledge of initial trauma care, district hospital capability to provide essential surgery, and the organization of trauma care. The good level of resources available in Botswana may be used to improve trauma care: To further this process, more empowering of high-volume trauma hospitals by adopting trauma-care recommendations and inclusive trauma-system approaches are desirable. The use of successful examples on enhanced surgical skills and capabilities, effective trauma-care resource management, and leadership should be encouraged.

System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

PubMed

Thoburn, E; Norris, P; Flores, R; Goode, S; Rodriguez, E; Adams, V; Campbell, S; Albrink, M; Rosemurgy, A

1993-01-01

A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

Promoting Teen Mothers' Mental Health.

PubMed

Freed, Patricia; SmithBattle, Lee

2016-01-01

In this second article in a two-part series, we call for the integration of strengths-based and trauma-informed care into services for teen mothers. Nurses working with teen mothers in health clinics, schools and home visiting programs can play a pivotal role in promoting their mental health. Many teen mothers have high levels of psychological distress and histories of adverse experiences that cannot be ignored, and cannot solely be addressed by referral to mental health services. Nurses must be prepared to assess for trauma and be open to listening to teen mothers' experiences. Principles of strengths-based and trauma-informed care are complementary and can be integrated in clinical services so that teen mothers' distress is addressed and their strengths and aspirations are supported. Potential screening tools, interviewing skills and basic strategies to alleviate teen mothers' distress are discussed.

Trauma transitional care coordination: A mature system at work.

PubMed

Hall, Erin C; Tyrrell, Rebecca L; Doyle, Karen E; Scalea, Thomas M; Stein, Deborah M

2018-05-01

We have previously demonstrated effectiveness of a Trauma Transitional Care Coordination (TTCC) Program in reducing 30-day readmission rates for trauma patients most at risk. With program maturation, we achieved improved readmission rates for specific patient populations. TTCC is a nursing driven program that supports patients at high risk for 30-day readmission. The TTCC interventions include calls to patients within 72 hours of discharge, complete medication reconciliation, coordination of medical appointments, and individualized problem solving. Account IDs were used to link TTCC patients with the Health Services Cost Review Commission database to collect data on statewide unplanned 30-day readmissions. Four hundred seventy-five patients were enrolled in the TTCC program from January 2014 to September 2016. Only 10.5% (n = 50) of TTCC enrollees were privately insured, 54.5% had Medicaid (n = 259), and 13.5% had Medicare (n = 64). Seventy-three percent had Health Services Cost Review Commission severity of injury ratings of 3 or 4 (maximum severity of injury = 4). The most common All Patient Refined Diagnosis Related Groups for participants were: lower-extremity procedures (n = 67, 14%); extensive abdominal/thoracic procedures (n = 40, 8.4%); musculoskeletal procedures (n = 37, 7.8%); complicated tracheostomy and upper extremity procedures (n = 29 each, 6.1%); infectious disease complications (n = 14, 2.9%); major chest/respiratory trauma, major small and large bowel procedures and vascular procedures (n = 13 each, 2.7%). The TTCC participants with lower-extremity injury, complicated tracheostomy, and bowel procedures had 6-point reduction (10% vs. 16%, p = 0.05), 11-point reduction (13% vs. 24%, p = 0.05), and 16-point reduction (11% vs. 27%, p = 0.05) in 30-day readmission rates, respectively, compared to those without TTCC. Targeted outpatient support for high-risk patients can decrease 30-day readmission rates. As our TTCC program matured, we reduced 30-day readmission in patients with lower-extremity injury, complicated tracheostomy and bowel procedures. This represents over one million-dollar savings for the hospital per year through quality-based reimbursement. Therapeutic/care management, level III.

The general surgery model: a more appealing and sustainable alternative for the care of trauma patients.

PubMed

Roettger, Richard H; Taylor, Spence M; Youkey, Jerry R; Blackhurst, Dawn W

2005-08-01

The contemporary model of trauma care where dedicated trauma/critical care surgeons exclusively manage trauma patients has become progressively unsustainable. Little objective data, however, is available documenting that a better model exists. From September 2002 through August 2003, the trauma model at a 735-bed level I trauma teaching hospital was changed from the contemporary model to a new one where selected general surgeons with Advanced Trauma Life Support (ATLS) certification covered in-house trauma and emergency surgery call on a rotational basis. As well, each pursued elective practices, admitting all inpatients (trauma, emergent, elective) to a single teaching service (formerly the trauma service). Critical care was managed by a separate group of intensivists. The purpose of this study was to objectively compare the two models. Quantitative, financial, and qualitative data were derived from August 2001 to January 2002 (trauma/critical care model) and compared to August 2003 to January 2004 (general surgery model). During the two periods (trauma/critical care vs general surgery), the mean Revised Trauma Score (7.1 vs 7.2; P = 0.029), the mean Injury Severity Score (ISS) (10.9 vs 10.8; P = 0.84), and the percentage of penetrating trauma (12.5% vs 13.2%; P = 0.79) were similar. Differences (trauma/critical care vs general surgery, % increase/P value) included average daily census (24 vs 54, 225%), cases/attending (262 vs 543, 207%), cases/resident (54 vs 262, 485%), charges/attending (353,811 dollars vs 471,725 dollars, 133%), collections/attending (106,143 dollars vs 165,103 dollars, 156%), number of trauma patients (643 vs 748, 116%), trauma mortality (7.3% vs 4.0%; P = 0.007), trauma mortality with ISS >15 (21.7% vs 12.0%; P = 0.035), trauma complications (33.1% vs 17%; P < 0.001), and ICU morbidity (66.8% vs 43.9%; P < .001). The new general surgery model produced superior financial results and better quantitative surgical experience while exceeding trauma and ICU quality outcomes compared to the former trauma/critical care model. These data objectively support a model such as ours--one that is financially sustainable and more professionally attractive.

Field trauma care in the 21st century.

PubMed

O'Reilly, D; König, T; Tai, N

2008-12-01

The nature of trauma care on the modern battlefield is changing quickly. Leading figures in UK field trauma care spoke at a recent meeting of the Haywood Club. The challenge of modern warfare, the evolving evacuation chain and the command and governance of field trauma care were explored.

Barriers to compliance with evidence-based care in trauma.

PubMed

Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

2012-03-01

We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols

PubMed Central

Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

2016-01-01

Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)—particularly in the pre-hospital care phase. Traditional trauma training protocols—such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)—have failed to produce an effective pre-hospital ground force of medical first responders. To overcome these barriers, we propose a new four-tiered set of trauma training protocols: Massive Open Online Course (MOOC) Trauma Training, Acute Trauma Training (ATT), Broad Trauma Training (BTT), and Cardiac and Trauma Training (CTT). These standards are specifically differentiated to accommodate the educational and socioeconomic diversity found in fast developing settings, where each free course is taught in native, lay language while ensuring the education standards are maintained by fully incorporating high-fidelity simulation, video-recorded debriefing, and retraining. The innovative pedagogy of this trauma education program utilizes MOOC for global scalability and a “train-the-trainer” approach for exponential growth—both components help fast developing countries reach a critical mass of first responders needed for the base of an evolving EMS. PMID:27419222

Strategically Leapfrogging Education in Prehospital Trauma Management: Four-Tiered Training Protocols.

PubMed

Abraham, Rohit; Vyas, Dinesh; Narayan, Mayur; Vyas, Arpita

2015-12-01

Trauma-related injury in fast developing countries are linked to 90% of international mortality rates, which can be greatly reduced by improvements in often non-existent or non-centralized emergency medical systems (EMS)-particularly in the pre-hospital care phase. Traditional trauma training protocols-such as Advanced Trauma Life Support (ATLS), International Trauma Life Support (ITLS), and Basic Life Support (BLS)-have failed to produce an effective pre-hospital ground force of medical first responders. To overcome these barriers, we propose a new four-tiered set of trauma training protocols: Massive Open Online Course (MOOC) Trauma Training, Acute Trauma Training (ATT), Broad Trauma Training (BTT), and Cardiac and Trauma Training (CTT). These standards are specifically differentiated to accommodate the educational and socioeconomic diversity found in fast developing settings, where each free course is taught in native, lay language while ensuring the education standards are maintained by fully incorporating high-fidelity simulation, video-recorded debriefing, and retraining. The innovative pedagogy of this trauma education program utilizes MOOC for global scalability and a "train-the-trainer" approach for exponential growth-both components help fast developing countries reach a critical mass of first responders needed for the base of an evolving EMS.

Evaluation of trauma care using TRISS method: the role of adjusted misclassification rate and adjusted w-statistic.

PubMed

Llullaku, Sadik S; Hyseni, Nexhmi Sh; Bytyçi, Cen I; Rexhepi, Sylejman K

2009-01-15

Major trauma is a leading cause of death worldwide. Evaluation of trauma care using Trauma Injury and Injury Severity Score (TRISS) method is focused in trauma outcome (deaths and survivors). For testing TRISS method TRISS misclassification rate is used. Calculating w-statistic, as a difference between observed and TRISS expected survivors, we compare our trauma care results with the TRISS standard. The aim of this study is to analyze interaction between misclassification rate and w-statistic and to adjust these parameters to be closer to the truth. Analysis of components of TRISS misclassification rate and w-statistic and actual trauma outcome. The component of false negative (FN) (by TRISS method unexpected deaths) has two parts: preventable (Pd) and non-preventable (nonPd) trauma deaths. Pd represents inappropriate trauma care of an institution; otherwise nonpreventable trauma deaths represents errors in TRISS method. Removing patients with preventable trauma deaths we get an Adjusted misclassification rate: (FP + FN - Pd)/N or (b+c-Pd)/N. Substracting nonPd from FN value in w-statistic formula we get an Adjusted w-statistic: [FP-(FN - nonPd)]/N, respectively (FP-Pd)/N, or (b-Pd)/N). Because adjusted formulas clean method from inappropriate trauma care, and clean trauma care from the methods error, TRISS adjusted misclassification rate and adjusted w-statistic gives more realistic results and may be used in researches of trauma outcome.

Feasibility of and Rationale for the Collection of Orthopaedic Trauma Surgery Quality of Care Metrics.

PubMed

Miller, Anna N; Kozar, Rosemary; Wolinsky, Philip

2017-06-01

Reproducible metrics are needed to evaluate the delivery of orthopaedic trauma care, national care, norms, and outliers. The American College of Surgeons (ACS) is uniquely positioned to collect and evaluate the data needed to evaluate orthopaedic trauma care via the Committee on Trauma and the Trauma Quality Improvement Project. We evaluated the first quality metrics the ACS has collected for orthopaedic trauma surgery to determine whether these metrics can be appropriately collected with accuracy and completeness. The metrics include the time to administration of the first dose of antibiotics for open fractures, the time to surgical irrigation and débridement of open tibial fractures, and the percentage of patients who undergo stabilization of femoral fractures at trauma centers nationwide. These metrics were analyzed to evaluate for variances in the delivery of orthopaedic care across the country. The data showed wide variances for all metrics, and many centers had incomplete ability to collect the orthopaedic trauma care metrics. There was a large variability in the results of the metrics collected among different trauma center levels, as well as among centers of a particular level. The ACS has successfully begun tracking orthopaedic trauma care performance measures, which will help inform reevaluation of the goals and continued work on data collection and improvement of patient care. Future areas of research may link these performance measures with patient outcomes, such as long-term tracking, to assess nonunion and function. This information can provide insight into center performance and its effect on patient outcomes. The ACS was able to successfully collect and evaluate the data for three metrics used to assess the quality of orthopaedic trauma care. However, additional research is needed to determine whether these metrics are suitable for evaluating orthopaedic trauma care and cutoff values for each metric.

[Modern concepts of trauma care and multiple trauma management in oral and maxillofacial region].

PubMed

Tan, Yinghui

2015-06-01

Multiple trauma management requires the application of modem trauma care theories. Optimal treatment results can be achieved by reinforcing cooperation and stipulating a treatment plan together with other disciplines. Based on modem theories in trauma care and our understanding of the theoretical points, this paper analyzes the injury assessment strategies and methods in oral and maxillofacial multiple trauma management. Moreover, this paper discusses operating time and other influencing factors as well as proposed definitive surgical timing and indications in comprehensive management of oral and maxillofacial multiple trauma patients associated with injuries in other body parts. We hope that this paper can help stomatological physicians deepen their understanding of modem trauma care theories and improve their capacity and results in the treatment of oral and maxillofacial multiple trauma.

Workplace disaster preparedness and response: the employee assistance program continuum of services.

PubMed

Paul, Jan; Blum, Dorothy

2005-01-01

Response programs for workplace critical and traumatic events are becoming an acknowledged and sought after standard of care. The current trauma literature recognizes what goes on in the workplace between the Employee Assistance Program (EAP) and management. The authors have taken this intra-organizational relationship, assimilated the information, and developed a model that recognizes and supports management throughout the continuum of response to workplace traumatic events. The model recognizes the EAP as an important workplace resource and tool in management's ability to strike the balance of managing the workforce while assisting in recovery following workplace trauma. The introduced concept defines the continuum and highlights the before, during, and after phases, showing how EAP supports management in most effectively doing their job.

Prehospital and emergency care research at the US Army Institute of Surgical Research: enabling the next great leap in combat casualty survival.

PubMed

Gerhardt, Robert T

2011-01-01

Minimizing preventable death continues to be a primary focus of the combat casualty care research community, and of the Army Medical Department as a whole. Toward that end, tremendous successes have been realized in resuscitative surgery, critical care, rehabilitation, preventive medicine, and in our collective ability to project effective medical care into the most austere locations throughout the globe. Innovation in the care rendered outside of theater hospitals or strategic air evacuation conveyances, however, has not kept the same pace. The US military experience in World War II, Korea, and Vietnam served as a prime source for the development of the tactics, techniques, and procedures which spawned modern civilian sector trauma care and emergency medical services. But this ascendance was driven by the dedicated medics, corpsmen, physicians, nurses, and allied health practitioners from those conflicts who left the military for the civilian sector, leaving their replacements, in many cases, to repeat the same mistakes, and to relearn hard lessons that otherwise might have been assimilated had they been effectively captured and integrated into doctrine and training. A prime example of this phenomenon is the recent acknowledgement of the "en route care gap" existing in tactical medical evacuation. The US Army Institute of Surgical Research (USAISR) and the Army emergency medicine community have made a significant commitment toward elucidating the requirements, capability gaps, and a way-forward in search of the development of an integrated prehospital combat casualty care system, nested within the Joint Theater Trauma System. This paper examines specific research programs, concept development, and collaborations with other Army, joint, and civilian center organizations which comprise the USAISR Prehospital and Emergency Care Research Program, including the Remote Damage Control Resuscitation initiative, Emergency Telemedical Direction of Role-I providers, Combat Medical Voice Documentation System, and establishment of the Remote Trauma Outcomes Research Network.

Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.

PubMed

Faul, Mark; Sasser, Scott M; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional trauma systems.

An Evaluation of Trauma Focused Cognitive Behavioral Therapy for Children in Zambia

PubMed Central

Murray, Laura K; Familiar, Itziar; Skavenski, Stephanie; Jere, Elizabeth; Cohen, Judy; Imasiku, Mwiya; Mayeya, John; Bass, Judith K; Bolton, Paul

2013-01-01

Objectives To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). Methods As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5–18 completed the TF-CBT treatment, with pre- and post-assessments. Results The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Conclusions Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the apprenticeship model of training and supervision. PMID:23768939

Amygdala volume in combat-exposed veterans with and without posttraumatic stress disorder: a cross-sectional study.

PubMed

Kuo, Janice R; Kaloupek, Danny G; Woodward, Steven H

2012-10-01

Data from animal models demonstrate a link between stress exposure and hypertrophic changes in the amygdala; however, studies of adults with posttraumatic stress disorder (PTSD) have failed to find analogous structural alterations. To compare amygdala volumes between a sample of combat veterans with and without PTSD (analysis 1) and examine whether our observation of larger amygdala volume in individuals with PTSD could be accounted for by the presence of trauma exposure in childhood and the severity of combat exposure in adulthood (analysis 2). Cross-sectional magnetic resonance imaging. Veterans Affairs Palo Alto Health Care System Inpatient Trauma Recovery Program and Veterans Affairs New England Health Care System Outpatient PTSD program. Ninety-nine combat-exposed veterans from the Vietnam Conflict or the Persian Gulf War who had been exposed to substantial military operational stress. Amygdala volume adjusted for total cerebral volume, Life Events Checklist, and the Combat Exposure Scale. Analysis 1 indicated that combat-exposed individuals with PTSD exhibited larger total amygdala volume compared with their non-PTSD counterparts (99 individuals, P = .047). Analysis 2 indicated that greater severity of combat exposure (87 individuals, P = .02), as well as the interaction between the presence of early life trauma and the severity of combat exposure (87 individuals, P = .008), were significantly associated with smaller total amygdala volume. The PTSD diagnosis continued to explain larger amygdala volume (87 individuals, P = .006). Posttraumatic stress disorder is associated with enlarged amygdala volume, above the variance accounted for by a history of early life trauma and severity of adult trauma exposure. The discrepancy between our and prior findings may be explained by variability in these trauma indices in previous investigations. These findings support additional study of amygdala structure in human stress disorders and further delineation of the role of early and adult trauma on associated neurologic changes.

Implementation and Evaluation of a Team Simulation Training Program.

PubMed

Rice, Yvonne; DeLetter, Mary; Fryman, Lisa; Parrish, Evelyn; Velotta, Cathie; Talley, Cynthia

2016-01-01

Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

Staying Connected: A Feasibility Study Linking American Indian and Alaska Native Trauma Survivors to their Tribal Communities

PubMed Central

Tsosie, Ursula; Nannauck, Sweetwater; Buchwald, Dedra; Russo, Joan; Geiss Trusz, Sarah; Foy, Hugh; Zatzick, Douglas

2013-01-01

The objective of this investigation was to assess the feasibility of a culturally tailored care management intervention for physically injured American Indian/Alaska Native (AI/AN) patients. The intervention was initiated at a Level I trauma center and aimed to link AI/AN patients to their distant tribal communities. Thirty AI/AN patients were randomized to the intervention or to usual care. Assessments at baseline, 3 months, and 6 months included self-reported lifetime cumulative trauma burden, Native healing requests, and symptoms of posttraumatic stress, depression, and alcohol use. Generalized estimating equations ascertained differences between groups over time. Ninety-four percent of eligible patients participated; follow-up at 3 and 6 months was 83%. Participants had high numbers of lifetime traumas (mean = 5.1, standard deviation = 2.6). No differences between the intervention and control groups were observed in posttraumatic stress symptoms, depression symptoms, or alcohol use at baseline or follow-up time points. Among intervention patients, 60% either requested or participated in traditional Native healing practices and 75% reported that the intervention was helpful. This effectiveness trial demonstrated the feasibility of recruiting and randomizing injured AI/AN patients. Future efforts could integrate evidence-based interventions and traditional Native healing into stepped collaborative care treatment programs. PMID:22168295

Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

PubMed

Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Hart, Melissa J; Sutherland, Ann M; Christie, Nicola

2013-02-18

To explore injured patients' experiences of trauma care to identify areas for improvement in service delivery. Qualitative study using in-depth, semi-structured interviews, conducted from 1 April 2011 to 31 January 2012, with 120 trauma patients registered by the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry and managed at the major adult trauma services (MTS) in Victoria. Emergent themes from patients' experiences of acute, rehabilitation and post-discharge care in the Victorian State Trauma System (VSTS). Patients perceived their acute hospital care as high quality, although 3s with communication and surgical management delays were common. Discharge from hospital was perceived as stressful, and many felt ill prepared for discharge. A consistent emerging theme was the sense of a lack of coordination of post-discharge care, and the absence of a consistent point of contact for ongoing management. Most patients' primary point of contact after discharge was outpatient clinics at the MTS, which were widely criticised because of substantial delays in receiving an appointment, prolonged waiting times, limited time with clinicians, lack of continuity of care and inability to see senior clinicians. This study highlights perceived 3s in the patient care pathway in the VSTS, especially those relating to communication, information provision and post-discharge care. Trauma patients perceived the need for a single point of contact for coordination of post-discharge care.

Increased Screening for Child Physical Abuse in Emergency Departments in a Regional Trauma System: Response to a Sentinel Event.

PubMed

Wilkins, Ginger G; Ball, Jane; Mann, N Clay; Nadkarni, Milan; Meredith, J Wayne

2016-01-01

A pediatric patient was assaulted while being treated at a Level 1 pediatric trauma center, prompting a Centers for Medicare & Medicaid Services site visit. The process of screening for physical abuse and protection of patients was reevaluated and revised, and a new guideline was implemented and shared with referral hospitals. During this same time period, 13 referral hospitals participated in an unrelated federally funded study determining the impact of recognition and care of injured children in states with and without a pediatric emergency care facility recognition program. A pre-post study analysis revealed that screening for abuse doubled during this time period.

The Evolution of the Society of Trauma Nurses' Leadership Institute.

PubMed

Krichten, Amy; Kyle, Amber

2015-01-01

The Society of Trauma Nurses (STN) understands the increasing complexity of trauma care and the vital leadership role nurses play. In 2009, the STN took the initiative to form a Leadership Committee tasked with researching the possibility of developing a mechanism to offer trauma leaders opportunities in leadership development. Investigation and collaboration among the committee members, with input from the Board of Directors and the organization's executive director, resulted in the STN Leadership Institute. The Leadership Institute design is to equip trauma nurses with the tools needed to effectively lead from the bedside to the boardroom and beyond through web-based modules. Operationalization of the plan took intense focus and dedicated leadership. Following a pilot study, the initial cohort ran the first quarter of 2015. Because of the positive feedback and identified opportunities for improvement, the program will continue to be offered with further expansion planning underway.

Exposing Compassion Fatigue and Burnout Syndrome in a Trauma Team: A Qualitative Study.

PubMed

Berg, Gina M; Harshbarger, Jenni L; Ahlers-Schmidt, Carolyn R; Lippoldt, Diana

2016-01-01

Compassion fatigue (CF) and burnout syndrome (BOS) are identified in trauma, emergency, and critical care nursing practices. The purpose of this qualitative study was to measure CF and BOS in a trauma team and allow them to share perceptions of related stress triggers and coping strategies. Surveys to measure CF and BOS and a focus group allowed a trauma team (12 practitioners) to share perceptions of related stress triggers and coping strategies. More than half scored at risk for CF and BOS. Stress triggers were described as situation (abuse, age of patient) versus injury-related. Personal coping mechanisms were most often reported. Both CF and BOS can be assessed with a simple survey tool. Strategies for developing a program culturally sensitive to CF and BOS are provided.

Trauma leadership: does perception drive reality?

PubMed

Sakran, Joseph V; Finneman, Bo; Maxwell, Chris; Sonnad, Seema S; Sarani, Babak; Pascual, Jose; Kim, Patrick; Schwab, C William; Sims, Carrie

2012-01-01

Leadership plays a key role in trauma team management and might affect the efficiency of patient care. Our hypothesis was that a positive relationship exists between the trauma team members' perception of leadership and the efficiency of the injured patient's initial evaluation. We conducted a prospective observational study evaluating trauma attending leadership (TAL) over 5 months at a level 1 trauma center. After the completion of patient care, trauma team members evaluated the TAL's ability using a modified Campbell Leadership Descriptor Survey tool. Scores ranged from 18 (ineffective leader) to 72 (perfect score). Clinical efficiency was measured prospectively by recording the time needed to complete an advanced trauma life support (ATLS)-directed resuscitation. Assessment times across Leadership score groups were compared using Kruskal-Wallis and Mann-Whitney tests (p < 0.05, statistically significant). Seven attending physicians were included with a postfellowship experience ranging from ≤1 to 11 years. The average leadership score was 59.8 (range, 27-72). Leadership scores were divided into 3 groups post facto: low (18-45), medium (46-67), and high (68-72). The teams directed by surgeons with low scores took significantly longer than teams directed by surgeons with high scores to complete the secondary survey (14 ± 4 minutes in contrast to 11 ± 2 minutes, p < 0.009) and to transport the patient for CT evaluation (19 ± 5 minutes in contrast to 14 ± 4 minutes; p < 0.001). Attending surgeon experience also affected clinical efficiency with teams directed by less experienced surgeons taking significantly longer to complete the primary survey (p < 0.05). The trauma team's perception of leadership is associated positively with clinical efficiency. As such, more formal leadership training could potentially improve patient care and should be included in surgical education. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Technical and financial feasibility of an inferior vena cava filter retrieval program at a level one trauma center.

PubMed

Charlton-Ouw, Kristofer M; Leake, Samuel S; Sola, Cristina N; Sandhu, Harleen K; Albarado, Rondel; Holcomb, John B; Miller, Charles C; Safi, Hazim J; Azizzadeh, Ali

2015-01-01

Considering new guidelines for retrievable inferior vena cava filters (IVCFs), we examine our initial experience after establishing a comprehensive filter removal program in our level 1 trauma center. We evaluated the technical and financial feasibility of this program and barriers to IVCF retrieval, including insurance status and costs, in trauma patients. Trauma patients receiving IVCFs from May 2011 to 2013 were consented and prospectively enrolled in the study program. Retrieval rates were assessed for the years before study initiation. Primary outcome was IVCF retrieval. Hospital financial data for retrieval were examined and univariate analysis performed. Hospital cost-to-charge and payment-to-charge ratios were assessed. Before study initiation from April 2009 to 2011, 66 IVCFs were placed in trauma patients with only 2 retrievals in 2 years. During the study period, 247 trauma patients had IVCF placement of which 111 (45%) were enrolled. The main reason for nonenrollment was lack of referral by the implanting team. Retrieval was attempted in 100 outpatients with success in 85 (85%). Patients enrolled in the program were more likely to have their filters removed (73% vs. 18%; odds ratio, 12.6; 95% confidence interval, 6.6-24.3; P < 0.001). Mean time from placement to attempt was 6.2 ± 4.0 months (range, 0.5-31.8). Of the total attempts, 29% were nonresource patients, 11% had Medicaid, and 60% had commercial insurance including Medicare patients. Chances of successful retrieval were higher if performed later during the study (P = 0.03). Successful retrieval was not related to insurance status (P = not significant). The mean total hospital charges related to retrieval were $4,493 (range, $2,510-$9,106). Successful retrieval contributed to lower total charges (P < 0.01). Factors contributing to higher total charges were retrieval attempt later in study period (P = 0.01) and commercial insurance status (P = 0.04). The rate of IVCF placement in trauma patients increased 4-fold over 4 years. The rate of IVCF retrieval increased more than 14-fold during the same period after establishment of the retrieval program. Elective outpatient retrieval of IVCFs in all eligible trauma patients is financially feasible without loss to the health care system even in regions with high rates of uninsured. A major barrier to successful filter retrieval was lack of patient referral into the program by implanting physicians. Hospital administration and physician outreach are important determinants of successful IVCF retrieval in trauma patients. Published by Elsevier Inc.

Trauma care at rural level III trauma centers in a state trauma system.

PubMed

Helling, Thomas S

2007-02-01

Although much has been written about the benefits of trauma center care, most experiences are urban with large numbers of patients. Little is known about the smaller, rural trauma centers and how they function both independently and as part of a larger trauma system. The state of Missouri has designated three levels of trauma care. The cornerstone of rural trauma care is the state-designated Level III trauma center. These centers are required to have the presence of a trauma team and trauma surgeon but do not require orthopedic or neurosurgical coverage. The purpose of this retrospective study was to determine how Level III trauma centers compared with Level I and Level II centers in the Missouri trauma system and, secondly, how trauma surgeon experience at these centers might shape future educational efforts to optimize rural trauma care. During a 2-year period in 2002 and 2003, the state trauma registry was queried on all trauma admissions for centers in the trauma system. Demographics and patient care outcomes were assessed by level of designation. Trauma admissions to the Level III centers were examined for acuity, severity, and type of injury. The experiences with chest, abdominal, and neurologic trauma were examined in detail. A total of 24,392 patients from 26 trauma centers were examined, including all eight Level III centers. Acuity and severity of injuries were higher at Level I and II centers. A total of 2,910 patients were seen at the 8 Level III centers. Overall deaths were significantly lower at Level III centers (Level I, 4% versus Level II, 4% versus Level III, 2%, p < 0.001). Numbers of patients dying within 24 hours were no different among levels of trauma care (Level I, 37% versus Level II, 30% versus Level III, 32%). Among Level III centers 45 (1.5%) patients were admitted in shock, and 48 (2%) had a Glasgow Coma Scale score <9. Twenty-six patients had a surgical head injury (7 epidural, 19 subdural hematomas). Twenty-eight patients (1%) needed a chest or abdominal operation. There were 15 spleen and 12 liver injuries with an Abbreviated Injury Score of 4 or 5. Level III trauma centers performed as expected in a state trauma system. Acuity and severity were less as was corresponding mortality. There were a paucity of life-threatening head, chest, and abdominal injuries, which provide a challenge to the rural trauma surgeon to maintain necessary skills in management of these critical injuries.

Effect of the Uniform Accident and Sickness Policy Provision Law on alcohol screening and intervention in trauma centers.

PubMed

Gentilello, Larry M; Donato, Anthony; Nolan, Susan; Mackin, Robert E; Liebich, Franesa; Hoyt, David B; LaBrie, Richard A

2005-09-01

Alcohol screening and intervention in trauma centers are widely recommended. The Uniform Accident and Sickness Policy Provision Law (UPPL) exists in most states, and allows insurers to refuse payment for treatment of injuries in patients with a positive alcohol or drug test. This article analyzed the UPPL's impact on screening and reimbursement, measured the knowledge of legislators about substance use problems in trauma centers, and determined their opinions about substance use-related exclusions in insurance contracts for trauma care. A nationwide survey of members of the American Association for the Surgery of Trauma was conducted. A separate survey of legislators who are members of the Senate, House, or Assembly and serve in some leadership role on committees responsible for insurance in their state was also performed. Ninety-eight trauma surgeon and 56 legislator questionnaires were analyzed. Surgeons' familiarity with the UPPL was limited; only 13% believed they practiced in a UPPL state, but 70% actually did. Despite lack of knowledge of the statute, 24% reported an alcohol- or drug-related insurance denial in the past 6 months. This appeared to affect screening practices; the majority of surgeons (51.5%) do not routinely measure blood alcohol concentration, even though over 91% believe blood alcohol concentration testing is important. Most (82%) indicated that if there were no insurance barriers, they would be willing to establish a brief alcohol intervention program in their center. Legislators were aware of the impact of substance use on trauma centers. They overwhelmingly agreed (89%) that alcohol problems are treatable, and 80% believed it is a good idea to offer counseling in trauma centers. As with surgeons, the majority (53%) were not sure whether the UPPL existed in their state, but they favored prohibiting alcohol-related exclusions by a 2:1 ratio, with strong bipartisan support. The study documents strong support for screening and intervention programs by both trauma surgeons and legislators. Surgeons experience alcohol-related insurance denials but are not familiar with the state law that sanctions this practice. A majority of legislators are also not familiar with the UPPL but support elimination of insurance statutes that allow exclusion of coverage for trauma care on the basis of intoxication.

Enhancing the population impact of collaborative care interventions: Mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma

PubMed Central

Zatzick, Douglas; Rivara, Frederick; Jurkovich, Gregory; Russo, Joan; Trusz, Sarah Geiss; Wang, Jin; Wagner, Amy; Stephens, Kari; Dunn, Chris; Uehara, Edwina; Petrie, Megan; Engel, Charles; Davydow, Dimitri; Katon, Wayne

2011-01-01

Objective To develop and implement a stepped collaborative care intervention targeting PTSD and related co-morbidities to enhance the population impact of early trauma-focused interventions. Method We describe the design and implementation of the Trauma Survivors Outcomes & Support Study (TSOS II). An interdisciplinary treatment development team was comprised of trauma surgical, clinical psychiatric and mental health services “change agents” who spanned the boundaries between front-line trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures. Results Two-hundred and seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing, and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by front-line acute care MSW and ARNP providers. Conclusions Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other non-specialty posttraumatic contexts. PMID:21596205

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

PubMed Central

Green, Bonnie L.; Saunders, Pamela A.; Power, Elizabeth; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Hurtado de Mendoza, Alejandra; Mete, Mihriye

2016-01-01

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs. PMID:27721673

Telephone-based goal management training for adults with mild traumatic brain injury: study protocol for a randomized controlled trial.

PubMed

Archer, Kristin R; Coronado, Rogelio A; Haislip, Lori R; Abraham, Christine M; Vanston, Susan W; Lazaro, Anthony E; Jackson, James C; Ely, E Wesley; Guillamondegui, Oscar D; Obremskey, William T

2015-06-02

Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to address these impairments, especially cognitive deficits in executive functioning. Goal management training (GMT) is a structured cognitive rehabilitation program that has been found to improve executive functioning in patients with moderate to severe TBI. The current study adapted the GMT program for telephone delivery in order to improve the accessibility of rehabilitation services in a patient population with multiple barriers to care and significant yet unrecognized cognitive impairment. The primary objective of this study is to examine the efficacy of telephone-based GMT for improving executive functioning, functional status, and psychological health in trauma survivors with mild TBI. This study is a three-group randomized controlled trial being conducted at a Level I trauma center. Ninety trauma survivors with mild TBI and cognitive deficits in executive functioning will be randomized to receive telephone-based GMT, telephone-based education, or usual care. GMT and education programs will be delivered by a physical therapist. The first in-person session is 1 h and the remaining six telephone sessions are 30 min. A battery of well-established cognitive tests will be conducted and validated questionnaires will be collected that measure executive functioning, functional status, and depressive and posttraumatic stress disorder symptoms at 6 weeks, 4 months, and 7 months following hospital discharge. This study supports a telephone-delivery approach to rehabilitation services in order to broaden the availability of evidence-based cognitive strategies. This trial was registered with Clinicaltrials.gov on 10 October 2012, registration number: NCT01714531.

Utilization and determinants of palliative care in the trauma intensive care unit: results of a national survey.

PubMed

Karlekar, Mohana; Collier, Bryan; Parish, Abby; Olson, Lori; Elasy, Tom

2014-09-01

There is a paucity of data evaluating utilization of palliative care in trauma intensive care units. We sought to determine current indications and determinants of palliative care consultation in the trauma intensive care units. Using a cross-sectional assessment, we surveyed trauma surgeons to understand indications, benefits, and barriers trauma surgeons perceive when consulting palliative care. A total of 1232 surveys were emailed to all members of the Eastern Association for the Surgery of Trauma. A total of 362 providers responded (29% response rate). Majority of respondents were male (n = 287, 80.2%) and practiced in Level 1 (n = 278, 77.7%) trauma centers. Most common indicators for referral to palliative care were expected survival 1 week to 1 month, multisystem organ dysfunction >3 weeks, minimal neurologic responsiveness >1 week, and referral to hospice. In post hoc analysis, there was a significant difference in frequency of utilization of palliative care when respondents had access to board-certified palliative care physicians (χ(2) = 56.4, p < 0.001). Although half of the respondents (n = 199, 55.6%) reported palliative care consults beneficial all or most of the time, nearly still half (n = 174, 48.6%) felt palliative care was underutilized. Most frequent barriers to consultation included resistance from families (n = 144, 40.2%), concerns that physicians were "giving up" (n = 109, 30.4%), and miscommunication of prognosis (n = 98, 27.4%) or diagnosis (n = 58, 16.2%) by the palliative care physician. Although a plurality of trauma surgeons reported palliative care beneficial, those surveyed indicate that palliative care is underutilized. Barriers identified provide important opportunities to further appropriate utilization of palliative care services. © The Author(s) 2014.

Aged care managers' perceptions of staff preparedness for caring for older survivors of genocide and mass trauma in Australia: How prepared are aged care workers?

PubMed

Teshuva, Karen; Wells, Yvonne

2017-03-01

To investigate aged care managers' perceptions of staff preparedness for working with older people who experienced genocide or mass trauma earlier in their lives (referred to in this paper as 'older survivors'). A survey of 60 aged care service managers was conducted (50% response rate). Trauma knowledge and skills scales with Cronbach's alpha scores of 0.74 and 0.90 respectively, were used. Scores across groups were compared using Student's t-tests. Three-quarters of the respondents reported that their agency had provided aged care services for older survivors. The majority of these managers perceived their staff to be moderately informed about trauma-related issues and half rated staff trauma-related skills positively. These ratings were positively associated with trauma-related staff training, service type and service location. Results suggest that, overall, managers perceive a need to improve aged care staff's preparedness for providing care for older survivors. © 2016 AJA Inc.

A Qualitative Evaluation of Barriers to Care for Trauma-Related Mental Health Problems Among Low-Income Minorities in Primary Care

PubMed Central

Chung, Joyce Y.; Frank, Lori; Subramanian, Asha; Galen, Steve; Leonhard, Sarah; Green, Bonnie L.

2012-01-01

This study aimed to identify barriers and facilitators of mental health care for patients with trauma histories via qualitative methods with clinicians and administrators from primary care clinics for the underserved. Individual interviews were conducted, followed by a combined focus group with administrators from three jurisdictions; there were three focus groups with clinicians from each clinic system. Common themes were identified, and responses from groups were compared. Administrators and clinicians report extensive trauma histories among patients. Clinician barriers include lack of time, patient resistance, and inadequate referral options; administrators cite reimbursement issues, staff training, and lack of clarity about the term trauma. A key facilitator is doctor-patient relationship. There were differences in perceived barriers and facilitators at the institutional and clinical levels for mental health care for patients with trauma. Importantly, there is agreement about better access to and development of trauma-specific interventions. Findings will aid the development and implementation of trauma-focused interventions embedded in primary care. PMID:22551798

Sexual trauma in the military: Exploring PTSD and mental health care utilization in female veterans.

PubMed

Kintzle, Sara; Schuyler, Ashley C; Ray-Letourneau, Diana; Ozuna, Sara M; Munch, Christopher; Xintarianos, Elizabeth; Hasson, Anthony M; Castro, Carl A

2015-11-01

Sexual trauma remains a pervasive problem in the military. The deleterious mental health outcomes related to incidents of sexual assault have been well-documented in the literature, with particular attention given to the development of posttraumatic stress disorder (PTSD) and utilization of mental health services. Much effort has focused on addressing issues of sexual trauma in the military. The purpose of this study was to examine the incidences of sexual assault in female veterans, the relationship to PTSD and mental health care utilization. The research explored differences in pre- and post-9/11 veterans. Data were collected using a 6-prong recruitment strategy to reach veterans living in Southern California. A total of 2,583 veterans completed online and in-person surveys, of which 325 female veterans were identified for inclusion in the analysis. Forty percent of the sample reported experiencing sexual assault during their military service. A history of military sexual trauma was found to be a substantial contributor to symptoms of PTSD. A majority of female veterans who indicated being sexually assaulted during their military service met the cutoff for a diagnosis of PTSD. Although only a minority of participants who indicated being a victim of sexual assault reported receiving immediate care after the incident, most had received mental health counseling within the past 12 months. Findings point to the need for additional prevention programs within the military and opportunities for care for victims of military sexual assault. (c) 2015 APA, all rights reserved).

Is trauma centre care helpful for less severely injured patients?

PubMed

Helling, Thomas S; Nelson, Paul W; Moore, B Todd; Kintigh, Denise; Lainhart, Kathy

2005-11-01

Trauma centres have been shown to reduce the number of preventable deaths from serious injuries. This is due largely to the rapid response of surgeons and health care teams to resuscitate, evaluate, and operate if necessary. Less is known about the effectiveness of trauma centre care on those patients who have not incurred immediate life-threatening problems and may not be as critically injured. The purpose of this study was to review the use of physician and hospital resources for this patient population to determine whether trauma team and trauma centre care is helpful or even needed. This was a retrospective study of consecutive trauma patients (n=1592) admitted from 1998 to 2002 to the trauma service of an urban level I trauma centre and recorded in the hospital trauma registry. Patients were triaged in a tiered response to more or less severely injured. All patients' care was directed by trauma surgeons. Of the 1592 patients, 398 (25%) received a full trauma team response (Class I), 1194 were less seriously injured (Class II). The ISS for the Class I patients was 19+/-18 and for Class II patients 10+/-10. Nineteen percent of Class II patients had an ISS>15. Overall mortality in Class II patients was 2% including 20 unexpected deaths. Four hundred and three Class II patients (34%) had multisystem injuries. Of the Class II patients 423 (35%) were sent to the ICU or OR from the ED, 106 of whom required an immediate operation and 345 required an operation prior to discharge. Complications developed in 129 patients (11%), the majority of which were pulmonary. A large proportion of those patients thought initially to be less severely injured required resources available in a trauma centre, including specialty care, intensive care, and operating room accessibility. Over one-third of these patients had multisystem injuries and almost 20% were considered major trauma, needing prioritisation of care and expertise ideally found in a trauma centre environment. Complications developed in a sizable number of patients. This patient population, because of its heterogeneity and propensity for critical illness, deserves the resources of a trauma centre.

Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on.

PubMed

LaGrone, Lacey N; Romaní Pozo, Diego A; Figueroa, Juan F; Artunduaga, Maria A; Huaman Egoavil, Eduardo; Rodriguez Castro, Manuel J A; Foianini, Jorge Esteban; Rubiano, Andrés M; Rodas, Edgar B; Mock, Charles N

2017-09-01

Trauma quality improvement (QI) programs have been shown to improve outcomes and decrease cost. These are high priorities in low- and middle-income countries (LMICs), where 2,000,000 deaths due to survivable injuries occur each year. We sought to define areas for improvement in trauma QI programs in four LMICs. We conducted a survey among trauma care providers in four Andean middle-income countries: Bolivia, Colombia, Ecuador, and Peru. 336 physicians, medical students, nurses, administrators and paramedical professionals responded to the cross-sectional survey with a response rate greater than 90% in all included countries except Bolivia, where the response rate was 14%. Eighty-seven percent of respondents reported morbidity and mortality (M&M) conferences occur at their hospital. Conferences were often reported as infrequent - 45% occurred less than every three months and poorly attended - 63% had five or fewer staff physicians present. Only 23% of conferences had standardized selection criteria, most lacked documentation - notes were taken at only 35% of conferences. Importantly, only 13% of participants indicated that discussions were routinely followed-up with any sort of corrective action. Multivariable analysis revealed the presence of standardized case selection criteria (OR 3.48, 95% CI 1.16-10.46), written documentation of the M&M conferences (OR 5.73, 95% CI 1.73-19.06), and a clear plan for follow-up (OR 4.80, 95% CI 1.59-14.50) to be associated with effective M&M conferences. Twenty-two percent of respondents worked at hospitals with a trauma registry. Fifty-two percent worked at institutions where autopsies were conducted, but only 32% of those reported the autopsy results to ever be used to improve hospital practice. M&M conferences are frequently practiced in the Andean region of Latin America but often lack methodologic rigor and thus effectiveness. Next steps in the maturation of QI programs include optimizing use of data from autopsies and registries, and systematic follow-up of M&M conferences with corrective action to ensure that these activities result in appreciable changes in clinical care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: A practice development process.

PubMed

Isobel, Sophie; Edwards, Clair

2017-02-01

Without agreeing on an explicit approach to care, mental health nurses may resort to problem focused, task oriented practice. Defining a model of care is important but there is also a need to consider the philosophical basis of any model. The use of Trauma Informed Care as a guiding philosophy provides a robust framework from which to review nursing practice. This paper describes a nursing workforce practice development process to implement Trauma Informed Care as an inpatient model of mental health nursing care. Trauma Informed Care is an evidence-based approach to care delivery that is applicable to mental health inpatient units; while there are differing strategies for implementation, there is scope for mental health nurses to take on Trauma Informed Care as a guiding philosophy, a model of care or a practice development project within all of their roles and settings in order to ensure that it has considered, relevant and meaningful implementation. The principles of Trauma Informed Care may also offer guidance for managing workforce stress and distress associated with practice change. © 2016 Australian College of Mental Health Nurses Inc.

Prehospital Trauma Care in Singapore.

PubMed

Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

2015-01-01

Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on “Developing Trauma Sciences and Injury Care in India”

PubMed Central

Pal, Ranabir; Agarwal, Amit; Galwankar, Sagar; Swaroop, Mamta; Stawicki, Stanislaw P; Rajaram, Laxminarayan; Paladino, Lorenzo; Aggarwal, Praveen; Bhoi, Sanjeev; Dwivedi, Sankalp; Menon, Geetha; Misra, MC; Kalra, OP; Singh, Ajai; Radjou, Angeline Neetha; Joshi, Anuja

2014-01-01

It is encouraging to see the much needed shift in the understanding and recognition of the concept of “burden of disease” in the context of traumatic injury. Equally important is understanding that the impact of trauma burden rivals that of nontraumatic morbidities. Subsequently, this paradigm shift reinstates the appeal for timely interventions as the standard for management of traumatic emergencies. Emergency trauma care in India has been disorganized due to inadequate sensitivity toward patients affected by trauma as well as the haphazard, nonuniform acceptance of standardization as the norm. Some of the major hospitals across various regions in the country do have trauma care units, but even those lack protocols to ensure that all trauma cases are handled by those units, largely owing to lack of structured referral system. As a first step to reform the state of trauma care in the country, a detailed overview is needed to gain insight into the prevailing reality. The objectives of this paper are to thus weave a foundation based on the statistical and qualitative burden of trauma in the country; the available infrastructure of trauma care centers equipped to deal with trauma; the need and scope of standardized protocols for intervention; and most importantly, the application of these in shaping educational initiatives in advancing emergency trauma care in the country. PMID:25024939

[How many generalists and how many specialists does orthopedics and traumatology need?].

PubMed

Achatz, G; Perl, M; Stange, R; Mutschler, M; Jarvers, J S; Münzberg, M

2013-01-01

The training in orthopedic and trauma surgery has changed significantly with the introduction of the new residency program. The contents taught have already been reduced in breadth and the current developments in the outpatient and particularly in the clinical landscape also contribute to increasing specialization. This trend favors structures in which comprehensive medical care for the population in Germany in orthopedic and trauma surgery appears to be endangered and in which the future efforts for e.g. polytraumatised patients need to be questioned. The Young Forum of the German Society for Orthopedics and Traumatology actively accompanies a discussion about the necessity and value of generalists to ensure the level of care in Germany in addition to the specialists.

Essential trauma care in Ghana: adaptation and implementation on the political tough road.

PubMed

Quansah, Robert

2006-06-01

The main goal of the Essential Trauma Care (EsTC) project is to promote affordable and sustainable improvements in trauma care, on the ground in individual countries and their health care facilities. This has been occurring in several countries, including Ghana. The EsTC project has helped to solidify previously haphazard interactions between stakeholders from different sectors. It has allowed trauma care clinicians to interact more effectively with other groups, such as the Ministry of Health and the WHO country office. It has allowed the clinicians and other stakeholders to more effectively lobby government for increased attention to trauma care services. These interactions have led to a high-profile stakeholders meeting, the Road Safety and Essential Trauma Care Workshop, which has represented the highest level of attention to trauma care in the country thus far. This meeting has generated a set of policy recommendations, which has been presented to Parliament for study, and, it is hoped, adoption. To convert these recommendations to solid, sustainable action in improving care for the injured, we need to continue to engage in advocacy and to work with Parliament, the Ministry of Health, and other stakeholders, as well as to confront the deeper problems of Ghana's brain drain, civil strife, and poverty.

Trauma health literacy: In need of remediation.

PubMed

Shahan, Charles P; Weinberg, Jordan A; Magnotti, Louis J; Fabian, Timothy C; Croce, Martin A

2016-12-01

Little is known regarding health literacy among trauma patients. Anecdotal experience at our institution has suggested that a profound lack of understanding of basic health care information exists at some level in our patients after hospital discharge. The purpose of this study was to report the results of a pilot quality improvement project to determine trauma patient injury comprehension and how this affects their overall satisfaction with care received. Trauma patients were surveyed for knowledge of their injuries, operations, and satisfaction with their care at the first outpatient visit following hospital discharge from a Level 1 trauma center. One hundred seventy-five surveys were distributed and 35 were returned complete and eligible for analysis. Average time from discharge to survey completion was 16 days. Seventy-five percent of patients were male, and the mean age was 37. Fifty-six percent of the injuries were from a blunt mechanism. Seventy-one percent reported household income of less than $25,000 per annum, and 61% had an education level of high school diploma or less. Forty percent of patients were unable to correctly recall their injuries, and 54% were unable to correctly recall operations performed. Seventy-two percent were unable to recall the name of any physician that provided care during their hospital stay. Nonetheless, 90% of patients were at least somewhat satisfied with their injury understanding, and only 3% felt that their level of understanding had a negative impact on their overall satisfaction with care received. There was no correlation between education or income level and ability to correctly recall injuries or operations. In addition, there was no correlation between ability to recall injuries or operations and patients' satisfaction. The observed deficiency in postdischarge health literacy among our patients is alarming and demonstrates that current hospital discharge education is lacking. Although this deficit did not affect satisfaction with care, we feel a responsibility to improve the health literacy of our patients. The next step at our institution will be to implement a revised discharge education program followed by surveillance to evaluate for improvement. Therapeutic/care management study, level IV.

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

PubMed

Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

2000-04-01

Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

PubMed Central

Midwinter, M

2013-01-01

Introduction Trauma provision in the UK is a topic of interest. Regional trauma networks and centres are evolving and research is blossoming, but what bearing does all this have on the care that is delivered to the individual patient? This article aims to provide an overview of key research concepts in the field of trauma care, to guide the clinician in decision making in the management of major trauma. Methods The Ovid MEDLINE®, EMBASE™ and PubMed databases were used to search for relevant articles on haemorrhage control, damage control resuscitation and its exceptions, massive transfusion protocols, prevention and correction of coagulopathy, acidosis and hypothermia, and damage-control surgery. Findings A wealth of research is available and a broad range has been reviewed to summarise significant developments in trauma care. Research has been categorised into disciplines and it is hoped that by considering each, a tailored management plan for the individual trauma patient will evolve, potentially improving patient outcome. PMID:23827287

Development of the major trauma case review tool.

PubMed

Curtis, Kate; Mitchell, Rebecca; McCarthy, Amy; Wilson, Kellie; Van, Connie; Kennedy, Belinda; Tall, Gary; Holland, Andrew; Foster, Kim; Dickinson, Stuart; Stelfox, Henry T

2017-02-28

As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater agreement was assessed for both the pilot and finalised versions of the tool. The final trauma case review tool contained ten sections, including patient factors (such as pre-existing conditions), presenting problem, a timeline of events, factors contributing to the care delivery problem (including equipment, work environment, staff action, organizational factors), positive aspects of care and the outcome of panel discussion. After refinement, the inter-rater reliability of the human factors and outcome components of the tool improved with an average 86% agreement between raters. This research developed an evidence-informed tool for use in paediatric trauma case review that considers both system safety and human factors to facilitate clinical review of trauma patient care. This tool can be used to identify opportunities for improvement in trauma care and guide quality assurance activities. Validation is required in the adult population.

Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation.

PubMed

Lang, Jason M; Campbell, Kimberly; Shanley, Paul; Crusto, Cindy A; Connell, Christian M

2016-05-01

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed. © The Author(s) 2016.

Determinants of resource needs and utilization among refugees over time.

PubMed

Wright, A Michelle; Aldhalimi, Abir; Lumley, Mark A; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E; Arnetz, Bengt B

2016-04-01

This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

Determinants of Resource Needs and Utilization Among Refugees Over Time

PubMed Central

Wright, A. Michelle; Aldhalimi, Abir; Lumley, Mark A.; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E.; Arnetz, Bengt B.

2015-01-01

Purpose This study examined refugees’ resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Methods Iraqi refugees to the United States (N=298) were assessed upon arrival and at 1-year intervals for two years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Results Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99% to 71%), other needs remained high (e.g., 99% of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Conclusions Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period. PMID:26370213

Alternative model for a pediatric trauma center: efficient use of physician manpower at a freestanding children's hospital.

PubMed

Vernon, Donald D; Bolte, Robert G; Scaife, Eric; Hansen, Kristine W

2005-01-01

Freestanding children's hospitals may lack resources, especially surgical manpower, to meet American College of Surgeons trauma center criteria, and may organize trauma care in alternative ways. At a tertiary care children's hospital, attending trauma surgeons and anesthesiologists took out-of-hospital call and directed initial care for only the most severely injured patients, whereas pediatric emergency physicians directed care for patients with less severe injuries. Survival data were analyzed using TRISS methodology. A total of 903 trauma patients were seen by the system during the period 10/1/96-6/30/01. Median Injury Severity Score was 16, and 508 of patients had Injury Severity Score > or =15. There were 83 deaths, 21 unexpected survivors, and 13 unexpected deaths. TRISS analysis showed that z-score was 4.39 and W-statistic was 3.07. Mortality outcome from trauma in a pediatric hospital using this alternative approach to trauma care was significantly better than predicted by TRISS methodology.

[World War II and current care provision: impact of war-related trauma on present professional care situations].

PubMed

Wilhelm, I; Zank, S

2014-07-01

This study represents the first empirical research into the impact of war-related trauma on present professional care situations in Germany. A total of 105 professional caregivers from North Rhine-Westphalia were questioned in a standardized form about the impact of war-related trauma on the daily work. Of the professional caregivers questioned 82%reported that they were already caring for a person suffering from post-war trauma and 77% stated that war-related trauma had an impact on the daily work. Altogether 63% reported that war-related trauma is highly significant for the daily work. The professional caregivers reported that there was often a lack of knowledge and awareness of the topic among colleagues. The study showed that there is a need for increasing awareness and providing further staff education and training regarding the treatment of people suffering from (war-related) trauma in order to ensure adequate care for those concerned.

Trauma exposure and PTSD among older adolescents in foster care.

PubMed

Salazar, Amy M; Keller, Thomas E; Gowen, L Kris; Courtney, Mark E

2013-04-01

Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma. Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions. The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience interpersonal violence and environmental trauma, while females were more likely to experience sexual trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants did. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation. Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence.

Nursing role innovations: improved outcomes in a trauma center.

PubMed

Holmquist, P J; Yamamoto, L; DiDonna, D; Sise, M J

1996-01-01

Trauma systems operate on the principle that people with severe injuries require special medical capabilities if they are to have their best chance of recovery. However, optimal trauma care is threatened by the problems of inadequate financial reimbursement. This threatens the ability to deliver trauma patient care. A variety of strategies is necessary to continue to provide care. Two specific nursing role innovations provide the opportunity to improve the ability to provide coordinated, efficient, and cost-effective quality care.

Serial Assessment of Trauma Care Capacity in Ghana in 2004 and 2014.

PubMed

Stewart, Barclay T; Quansah, Robert; Gyedu, Adam; Boakye, Godfred; Abantanga, Francis; Ankomah, James; Donkor, Peter; Mock, Charles

2016-02-01

Trauma care capacity assessments in developing countries have generated evidence to support advocacy, detailed baseline capabilities, and informed targeted interventions. However, serial assessments to determine the effect of capacity improvements or changes over time have rarely been performed. To compare the availability of trauma care resources in Ghana between 2004 and 2014 to assess the effects of a decade of change in the trauma care landscape and derive recommendations for improvements. Capacity assessments were performed using direct inspection and structured interviews derived from the World Health Organization's Guidelines for Essential Trauma Care. In Ghana, 10 hospitals in 2004 and 32 hospitals in 2014 were purposively sampled to represent those most likely to care for injuries. Clinical staff, administrators, logistic/procurement officers, and technicians/biomedical engineers who interacted, directly or indirectly, with trauma care resources were interviewed at each hospital. Availability of items for trauma care was rated from 0 (complete absence) to 3 (fully available). Factors contributing to deficiency in 2014 were determined for items rated lower than 3. Each item rated lower than 3 at a specific hospital was defined as a hospital-item deficiency. Scores for total number of hospital-item deficiencies were derived for each contributing factor. There were significant improvements in mean ratings for trauma care resources: district-level (smaller) hospitals had a mean rating of 0.8 for all items in 2004 vs 1.3 in 2014 (P = .002); regional (larger) hospitals had a mean rating of 1.1 in 2004 vs 1.4 in 2014 (P = .01). However, a number of critical deficiencies remain (eg, chest tubes, diagnostics, and orthopedic and neurosurgical care; mean ratings ≤ 2). Leading contributing factors were item absence (503 hospital-item deficiencies), lack of training (335 hospital-item deficiencies), and stockout of consumables (137 hospital-item deficiencies). There has been significant improvement in trauma care capacity during the past decade in Ghana; however, critical deficiencies remain and require urgent redress to avert preventable death and disability. Serial capacity assessment is a valuable tool for monitoring efforts to strengthen trauma care systems, identifying what has been successful, and highlighting needs.

Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy

PubMed Central

Murshid, Nadine Shaanta

2016-01-01

Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, we have argued that the principles of trauma-informed care can be extended to social policy. Citing a variety of health-related policy examples, we have described how policy can better reflect 6 core principles of trauma-informed care: safety, trustworthiness and transparency, collaboration, empowerment, choice, and intersectionality. This framework conveys a politicized understanding of trauma, reflecting the reality that trauma and its effects are not equally distributed, and offers a pathway for public health professionals to disrupt trauma-driven health disparities through policy action. PMID:26691122

The role of the trauma nurse leader in a pediatric trauma center.

PubMed

Wurster, Lee Ann; Coffey, Carla; Haley, Kathy; Covert, Julia

2009-01-01

The trauma nurse leader role was developed by a group of trauma surgeons, hospital administrators, and emergency department and trauma leaders at Nationwide Children's Hospital who recognized the need for the development of a core group of nurses who provided expert trauma care. The intent was to provide an experienced group of nurses who could identify and resolve issues in the trauma room. Through increased education, exposure, mentoring, and professional development, the trauma nurse leader role has become an essential part of the specialized pediatric trauma care provided at Nationwide Children's Hospital.

Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol

PubMed Central

Fleet, Richard; Tounkara, Fatoumata Korika; Ouimet, Mathieu; Dupuis, Gilles; Poitras, Julien; Tanguay, Alain; Fortin, Jean Paul; Trottier, Jean-Guy; Ouellet, Jean; Lortie, Gilles; Plant, Jeff; Morris, Judy; Chauny, Jean Marc; Lauzier, François; Légaré, France

2016-01-01

Introduction Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. Methods and analysis The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009–2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). Ethics and dissemination This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals. PMID:27098826

The pathway to grandparenting stress: trauma, relational conflict, and emotional well-being.

PubMed

Sprang, Ginny; Choi, Moon; Eslinger, Jessica G; Whitt-Woosley, Adrienne L

2015-01-01

This paper examines the mediating effect of child-grandparent conflict on the relationship between child trauma exposure and grandparenting stress. Data was collected from a sample of custodial grandparents who participated in kinship care or relative caregiving programs (n = 251). Grandparenting stress was measured with Parenting Stress Scale (Berry & Jones, 1995 ) modified for grandparents. A series of regression models and structural equation models (SEM) were used to test the relationship between the number of different types of child trauma exposures and grandparenting stress, and to examine the mediating effect of child-grandparent conflicts on the relationship. Almost three-fourths (72%) of children had experienced at least one type of traumatic exposure. The SEM model shows that child's trauma exposure indirectly affected grandparenting stress, mediated by child-grandparenting conflicts though no direct path between the child's trauma exposure variable and grandparenting stress was found. A higher level of child-grandparent conflicts was also associated with a lower level of emotional well-being among custodial grandparents. Based on these findings, recommendations are made about how to tailor a trauma-informed approach to the needs of custodial grandparents.

Temporal distribution of trauma deaths: quality of trauma care in a developing country.

PubMed

Masella, Cesar Augusto; Pinho, Vitor Ferreira; Costa Passos, Afonso Dinis; Spencer Netto, Fernando A C; Rizoli, Sandro; Scarpelini, Sandro

2008-09-01

Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care. The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas. We analyzed the National Health Minister's System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001. During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%). The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.

Project Kealahou: Improving Hawai‘i's System of Care for At-Risk Girls and Young Women through Gender-Responsive, Trauma-Informed Care

PubMed Central

Jackson, David S; Slavin, Lesley A; Michels, M Stanton; McGeehan, Kathleen M

2014-01-01

Project Kealahou (PK) is a six-year, federally-funded program aimed at improving services and outcomes for Hawai‘i's female youth who are at risk for running away, truancy, abuse, suicide, arrest and incarceration. PK builds upon two decades of sustained cross-agency efforts among the state's mental health, juvenile justice, education, and child welfare systems to promote system-of-care (SOC) principles of community-based, individualized, culturally and linguistically competent, family driven, youth-guided, and evidence-based services. In addition, PK emphasizes trauma-informed and gender-responsive care in serving its target population of females ages 11–18 years who have experienced psychological trauma. Results from the first four years of the implementation of PK in the Department of Health's (DOH) Child and Adolescent Mental Health Division (CAMHD) highlight the serious familial, socioeconomic, functional, and interpersonal challenges faced by the young women who receive services in Hawai‘i's SOC. Despite the challenges faced by PK youth and their families, preliminary results of the evaluation of PK show significant improvements across multiple clinical and functional domains of service recipients. A financial analysis indicates that these outcomes were obtained with a minimal overall increase in costs when compared to standard care alone. Overall, these results suggest that PK may offer a cost effective way to improve access, care, and outcomes for at-risk youth and their families in Hawai‘i. PMID:25628971

Perspectives of hospital emergency department staff on trauma-informed care for injured children: An Australian and New Zealand analysis.

PubMed

Hoysted, Claire; Babl, Franz E; Kassam-Adams, Nancy; Landolt, Markus A; Jobson, Laura; Curtis, Sarah; Kharbanda, Anupam B; Lyttle, Mark D; Parri, Niccolò; Stanley, Rachel; Alisic, Eva

2017-09-01

To examine Australian and New Zealand emergency department (ED) staff's training, knowledge and confidence regarding trauma-informed care for children after trauma, and barriers to implementation. ED staff's perspectives on trauma-informed care were assessed using a web-based self-report questionnaire. Participants included 468 ED staff (375 nursing and 111 medical staff) from hospitals in Australia and New Zealand. Data analyses included descriptive statistics, χ 2 tests and multiple regressions. Over 90% of respondents had not received training in trauma-informed care and almost all respondents (94%) wanted training in this area. While knowledge was associated with a respondent's previous training and profession, confidence was associated with the respondent's previous training, experience level and workplace. Dominant barriers to the implementation of trauma-informed care were lack of time and lack of training. There is a need and desire for training and education of Australian and New Zealand ED staff in trauma-informed care. This study demonstrates that experience alone is not sufficient for the development of knowledge of paediatric traumatic stress reactions and trauma-informed care practices. Existing education materials could be adapted for use in the ED and to accommodate the training preferences of Australian and New Zealand ED staff. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

The invisible trauma patient: emergency department discharges.

PubMed

Reilly, Patrick M; Schwab, C William; Kauder, Donald R; Dabrowski, G Paul; Gracias, Vicente; Gupta, Rajan; Pryor, John P; Braslow, Benjamin M; Kim, Patrick; Wiebe, Douglas J

2005-04-01

As the malpractice and financial environment has changed, injured patients evaluated by the trauma team and discharged from the emergency department (ED) are now commonplace. The evaluation, care, and disposition of this population has become a significant workload component but is not reported to accrediting organizations and is relatively invisible to hospital administrators. Our objective was to quantify and begin to qualify the evolving picture of the trauma ED discharge population as a work component of trauma service function in an urban, Level I trauma center with an aeromedical program. Trauma registry (contacts, mechanism, transport, injuries, and disposition) and hospital databases (ED closure, occupancy rates) were queried for a 5-year period (1999-2003). Trend analysis provided statistical comparisons for questions of interest. During the 5-year study period, the total number of trauma contacts rose by 18.1% (2,220 in 1999 vs. 2,622 in 2003; trend p < 0.05). This increase in total contacts was not a manifestation of an increase in admissions (1,672 in 1999 vs. 1,544 in 2003) but rather a reflection of a marked increase in patients seen primarily by the trauma team and discharged from the ED (473 in 1999 vs. 1,000 in 2003; trend p < 0.05). These ED discharge patients were increasingly transported by helicopter (12.3% in 1999 vs. 29.2% in 2003; trend p < 0.05) and less frequently from urban areas (57.1% in 1999 vs. 48.1% in 2003; trend p < 0.05) over the course of the study period. Average injury severity of this group increased over the study period (Injury Severity Score of 2.7 +/- 0.1 in 1999 vs. 3.3 +/- 0.1 in 2003; trend p < 0.05). ED length of stay for this group increased 19.8% over the study period (trend p < 0.05), averaging nearly 5 hours in 2003. The total number, relative percentage, and injury severity of patients evaluated by the trauma team and discharged from the ED has significantly increased over the last 5 years, representing nearly 5,000 patient care hours in 2003. Systems to care for these patients in a cost- and resource-efficient fashion should be put in place. The impact of this growing population of patients on the workload of the trauma center should be recognized by accrediting agencies, hospital administration, and Emergency Medical Services.

The Incidence of Fever in US Critical Care Air Transport Team Combat Trauma Patients Evacuated from the Theater between March 2009 and March 2010

DTIC Science & Technology

2013-11-01

THE INCIDENCE OF FEVER IN US CRITICAL CARE AIR TRANSPORT TEAM COMBAT TRAUMA PATIENTS EVACUATED FROM THE THEATER BETWEEN MARCH 2009 AND MARCH 2010...Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are...248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever . The mean age was 28 years, and 98% of patients were men. The

Trauma Experiences, Maltreatment-Related Impairments, and Resilience among Child Welfare Youth in Residential Care

ERIC Educational Resources Information Center

Collin-Vezina, Delphine; Coleman, Kim; Milne, Lise; Sell, Jody; Daigneault, Isabelle

2011-01-01

The aim of this paper was to provide a description of the trauma experiences, trauma-related sequels, and resilience features of a sample of Canadian youth in residential care facilities, as well as to explore the impact of gender and of the number of different traumas experienced on trauma-related sequels and resilience features. A convenience…

Web-Based Simulation in Psychiatry Residency Training: A Pilot Study

ERIC Educational Resources Information Center

Gorrindo, Tristan; Baer, Lee; Sanders, Kathy M.; Birnbaum, Robert J.; Fromson, John A.; Sutton-Skinner, Kelly M.; Romeo, Sarah A.; Beresin, Eugene V.

2011-01-01

Background: Medical specialties, including surgery, obstetrics, anesthesia, critical care, and trauma, have adopted simulation technology for measuring clinical competency as a routine part of their residency training programs; yet, simulation technologies have rarely been adapted or used for psychiatry training. Objective: The authors describe…

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries

PubMed Central

Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

2015-01-01

Introduction Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Methods Consensus on trauma care audit filters was built between twenty panelists using a Delphi technique with four anonymous, iterative surveys designed to elicit: i) trauma care processes to be measured; ii) important features of audit filters for the district-level hospital setting; and iii) potentially useful filters. Filters were ranked on a scale from 0 – 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Results Panelists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1 - 0.58; Round 2 - 0.66; Round 3 - 0.76; and Round 4 - 0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage - vital signs are recorded within 15 minutes of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation - a large bore IV was placed within 15 minutes of patient arrival; referral - if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. Conclusion This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step toward improving care for the injured at district-level hospitals in LMICs. PMID:26492882

Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres.

PubMed

Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B

2018-01-01

Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention. Copyright © 2017 Elsevier Ltd. All rights reserved.

[First aid for multiple trauma patients: investigative survey in the Firenze-Bologna area].

PubMed

Crescioli, G L; Donati, D; Federici, A; Rasero, L

1999-01-01

Overall mortality ascribable to multiple traumas, that in Italy is responsible for about 8,000 death/year, is strictly dependent on the function of the so called Trauma Care System. This study reports on an epidemiological survey conducted in the urban area of Florence along a 23-month period (from Jan 97 to Nov 99), with the aim to identify the typology of traumas and the first aid care delivered to the person until hospital admission. These data were compared to those collected in the urban area of Bologna because the composition of the first-aid team is different, being nurses, in Bologna, an integral component of the first aid system. On a total of 118 multiple traumas, 17% was represented by isolated head trauma, while in 72% involvement of other organs was present in addition to the head; 11% of cases were abdominal or thoracic traumas, 1% of lower extremities. In 46% the cause of trauma was a car accident. The complexity of care delivered to the person with trauma was less in the Florence survey, as indicated by the immobilization of patients, performed in only 11% of cases as compared to 47% in Bologna, by the application of the cervical collar, applied in 12% versus 62% of traumas. Although the two samples are not strictly comparable, these data suggest that the presence of nurses in the Trauma Care System can be one of the elements of improvement of the quality of delivered care.

An overview of New Zealand's trauma system.

PubMed

Paice, Rhondda

2007-01-01

Patterns of trauma and trauma systems in New Zealand are similar to those in Australia. Both countries have geographical considerations, terrain and distance, that can cause delay to definitive care. There are only 7 hospitals in New Zealand that currently manage major trauma patients, and consequently, trauma patients are often hospitalized some distance from their homes. The prehospital services are provided by one major provider throughout the country, with a high level of volunteers providing these services in the rural areas. New Zealand has a national no-fault accident insurance system, the Accident Compensation Corporation, which funds all trauma-related healthcare from the roadside to rehabilitation. This insurance system provides 24-hour no-fault personal injury insurance coverage. The Accident Compensation Corporation provides bulk funding to hospitals for resources to manage the care of trauma patients. Case managers are assigned for major trauma patients. This national system also has a rehabilitation focus. The actual funds are managed by the hospitals, and this allows hospital staff to provide optimum care for trauma patients. New Zealand works closely with Australia in the development of a national trauma registry, research, and education in trauma care for patients in Australasia (the islands of the southern Pacific Ocean, including Australia, New Zealand, and New Guinea).

Advanced Practitioners Are Peers in Trauma Performance Improvement Peer Review.

PubMed

Collins, Tara Ann; Sicoutris, Corinna P; McNicholas, Amanda; Krumrie, Nicole; Eddinger, Abby; Fernandez, Forrest B; Schwab, C William; Reilly, Patrick M; Kim, Patrick K

2016-01-01

Advanced practitioners (APs) have been successfully integrated into the clinical care of injured patients. Given the expanding role of APs in trauma care, we hypothesized that APs can perform Performance Improvement and Patient Safety (PIPS) peer review at a level comparable with trauma surgeons. For Phase 1, cases previously reviewed by a trauma surgeon were randomly selected by the PIPS coordinator and peer reviewed by an AP. The trauma surgeons' and APs' reviews were compared. For Phase 2, cases requiring concurrent review were peer reviewed by both an AP and an MD, who were blinded to each other's review. Both the APs' and trauma surgeons' reviews of the same medical record were presented at a bimonthly performance improvement (PI) meeting. In Phase 1, 46 PI cases were reviewed including 22 deaths. Trauma surgeons and APs had high concordance (96.0%) regarding appropriateness or inappropriateness of care (κ = 0.774). Among disagreements, APs were 3 times more likely than trauma surgeons to determine care to be inappropriate. Trauma surgeons and APs had similarly high concordance (95.5%) regarding preventability of mortality (κ = 0.861). In Phase 2, 38 PI cases were reviewed, including 31 deaths. Trauma surgeons and APs had high concordance (89.0%) regarding appropriateness or inappropriateness of care (κ = 0.585). Among disagreements, trauma surgeons and APs had similarly high concordance (86.2%) regarding preventability of mortality (κ = 0.266). We found that APs had high concordance with trauma surgeons regarding medical record reviews and are thus able to effectively review medical records for the purposes of PIPS.

Distribution of Trauma Care Facilities in Oman in Relation to High-Incidence Road Traffic Injury Sites: Pilot study.

PubMed

Al-Kindi, Sara M; Naiem, Ahmed A; Taqi, Kadhim M; Al-Gheiti, Najla M; Al-Toobi, Ikhtiyar S; Al-Busaidi, Nasra Q; Al-Harthy, Ahmed Z; Taqi, Alaa M; Ba-Alawi, Sharif A; Al-Qadhi, Hani A

2017-11-01

Road traffic injuries (RTIs) are considered a major public health problem worldwide. In Oman, high numbers of RTIs and RTI-related deaths are frequently registered. This study aimed to evaluate the distribution of trauma care facilities in Oman with regards to their proximity to RTI-prevalent areas. This descriptive pilot study analysed RTI data recorded in the national Royal Oman Police registry from January to December 2014. The distribution of trauma care facilities was analysed by calculating distances between areas of peak RTI incidence and the closest trauma centre using Google Earth and Google Maps software (Google Inc., Googleplex, Mountain View, California, USA). A total of 32 trauma care facilities were identified. Four facilities (12.5%) were categorised as class V trauma centres. Of the facilities in Muscat, 42.9% were ranked as class IV or V. There were no class IV or V facilities in Musandam, Al-Wusta or Al-Buraimi. General surgery, orthopaedic surgery and neurosurgery services were available in 68.8%, 59.3% and 12.5% of the centres, respectively. Emergency services were available in 75.0% of the facilities. Intensive care units were available in 11 facilities, with four located in Muscat. The mean distance between a RTI hotspot and the nearest trauma care facility was 34.7 km; however, the mean distance to the nearest class IV or V facility was 83.3 km. The distribution and quality of trauma care facilities in Oman needs modification. It is recommended that certain centres upgrade their levels of trauma care in order to reduce RTI-associated morbidity and mortality in Oman.

Minimal acceptable care as a vital component to Missouri's trauma system.

PubMed

Helling, Thomas S

2002-07-01

Immediate attention to life-threatening injuries and expeditious transfer of major and complex wounds to tertiary care trauma centers are the cornerstones of any trauma system. Rapid assessment and "minimalization" of care should be the buzz-word of rural (Level III) and suburban (Level II) trauma centers in order to provide quickest treatment of injuries by timely referral of patients for definitive attention. This concept is called minimal acceptable care and may serve to improve patient outcome by reducing the interval to ultimate treatment and avoidance of duplication of services.

The identification of criteria to evaluate prehospital trauma care using the Delphi technique.

PubMed

Rosengart, Matthew R; Nathens, Avery B; Schiff, Melissa A

2007-03-01

Current trauma system performance improvement emphasizes hospital- and patient-based outcome measures such as mortality and morbidity, with little focus upon the processes of prehospital trauma care. Little data exist to suggest which prehospital criteria should serve as potential filters. This study identifies the most important filters for auditing prehospital trauma care using a Delphi technique to achieve consensus of expert opinion. Experts in trauma care from the United States (n = 81) were asked to generate filters of potential utility in monitoring the prehospital aspect of the trauma system, and were then required to rank these questions in order of importance to identify those of greatest importance. Twenty-eight filters ranking in the highest tertile are proposed. The majority (54%) pertains to aspects of emergency medical services, which comprise 7 of the top 10 (70%) filters. Triage filters follow in priority ranking, comprising 29% of the final list. Filters concerning interfacility transfers and transportation ranked lowest. This study identifies audit filters representing the most important aspects of prehospital trauma care that merit continued evaluation and monitoring. A subsequent trial addressing the utility of these filters could potentially enhance the sensitivity of identifying deviations in prehospital care, standardize the performance improvement process, and translate into an improvement in patient care and outcome.

European trauma guideline compliance assessment: the ETRAUSS study.

PubMed

Hamada, Sophie Rym; Gauss, Tobias; Pann, Jakob; Dünser, Martin; Leone, Marc; Duranteau, Jacques

2015-12-08

Haemorrhagic shock is the leading cause of preventable death in trauma patients. The 2013 European trauma guidelines emphasise a comprehensive, multidisciplinary, protocol-based approach to trauma care. The aim of the present Europe-wide survey was to compare 2015 practice with the 2013 guidelines. A group of members of the Trauma and Emergency Medicine section of the European Society of Intensive Care Medicine developed a 50-item questionnaire based upon the core recommendations of the 2013 guidelines, employing a multistep approach. The questionnaire covered five fields: care structure and organisation, haemodynamic resuscitation targets, fluid management, transfusion and coagulopathy, and haemorrhage control. The sampling used a two-step approach comprising initial purposive sampling of eminent trauma care providers in each European country, followed by snowball sampling of a maximum number of trauma care providers. A total of 296 responses were collected, 243 (81 %) from European countries. Those from outside the European Union were excluded from the analysis. Approximately three-fourths (74 %) of responders were working in a designated trauma centre. Blunt trauma predominated, accounting for more than 90 % of trauma cases. Considerable heterogeneity was observed in all five core aspects of trauma care, along with frequent deviations from the 2013 guidelines. Only 92 (38 %) of responders claimed to comply with the recommended systolic blood pressure target, and only 81 (33 %) responded that they complied with the target pressure in patients with traumatic brain injury. Crystalloid use was predominant (n = 209; 86 %), and vasopressor use was frequent (n = 171, 76 %) but remained controversial. Only 160 respondents (66 %) declared that they used tranexamic acid always or often. This is the first European trauma survey, to our knowledge. Heterogeneity is significant across centres with regard to the clinical protocols for trauma patients and as to locally available resources. Deviations from guidelines are frequent, differ from region to region and are dependent upon specialty training. Further efforts are required to provide consensus guidelines and to improve their implementation across European countries.

Trauma healing in refugee camps in Guinea: a psychosocial program for Liberian and Sierra Leonean survivors of torture and war.

PubMed

Stepakoff, Shanee; Hubbard, Jon; Katoh, Maki; Falk, Erika; Mikulu, Jean-Baptiste; Nkhoma, Potiphar; Omagwa, Yuvenalis

2006-11-01

From 1999 to 2005, the Minneapolis-based Center for Victims of Torture (CVT) served Liberian and Sierra Leonean survivors of torture and war living in the refugee camps of Guinea. A psychosocial program was developed with 3 main goals: (a) to provide mental health care, (b) to train local refugee counselors, and (c) to raise community awareness about war trauma and mental health. Utilizing paraprofessional counselors under the close, on-site supervision of expatriate clinicians, the treatment model blended elements of Western and indigenous healing. The core component consisted of relationship-based supportive group counseling. Clinical interventions were guided by a 3-stage model of trauma recovery (safety, mourning, reconnection), which was adapted to the realities of the refugee camp setting. Over 4,000 clients were provided with counseling, and an additional 15,000 were provided with other supportive services. Results from follow-up assessments indicated significant reductions in trauma symptoms and increases in measures of daily functioning and social support during and after participation in groups. The treatment model developed in Guinea served as the basis for CVT's ongoing work with survivors in Sierra Leone and Liberia. ((c) 2006 APA, all rights reserved).

Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology

PubMed Central

Whalen, Desmond; Harty, Chris; Ravalia, Mohamed; Renouf, Tia; Alani, Sabrina; Brown, Robert

2016-01-01

The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs. PMID:27081585

The value of trauma registries.

PubMed

Moore, Lynne; Clark, David E

2008-06-01

Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

Positive and negative volume-outcome relationships in the geriatric trauma population.

PubMed

Matsushima, Kazuhide; Schaefer, Eric W; Won, Eugene J; Armen, Scott B; Indeck, Matthew C; Soybel, David I

2014-04-01

In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly, or to the case volume among all trauma patients treated by an institution. To test the hypothesis that outcomes of trauma care for geriatric patients are affected differently by the volume of geriatric cases and nongeriatric cases of an institution. This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39 431 eligible geriatric trauma patients (aged >65 years) in the Pennsylvania Trauma Outcomes Study. In-hospital mortality, major complications, and mortality after major complications (failure to rescue). Between 2001 and 2010, 39 431 geriatric trauma patients and 105 046 nongeriatric patients were captured in a review of outcomes in 20 state-designated levels 1 and 2 trauma centers. Larger volumes of geriatric trauma patients were significantly associated with lower odds of in-hospital mortality, major complications, and failure to rescue. In contrast, larger nongeriatric trauma volumes were significantly associated with higher odds of major complications in geriatric patients. Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients. These findings offer the possibility that outcomes might be improved with differentiated pathways of care for geriatric trauma patients.

Understanding and Addressing the Global Need for Orthopaedic Trauma Care.

PubMed

Agarwal-Harding, Kiran J; von Keudell, Arvind; Zirkle, Lewis G; Meara, John G; Dyer, George S M

2016-11-02

➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

A Program for Clinical Care in Physical Trauma.

DTIC Science & Technology

1976-03-01

nitrogen balance in fasting man. Carbohydrate at all levels of infusion markedly improves the utilization of amino acids. Thus, ketosis does not seem...specific- .4 ally, nor ketosis as a whole, in any way favors nitrogen economy. The impression gained from the literature that ketosis is a favorable

Early response to psychological trauma--what GPs can do.

PubMed

Wade, Darryl; Howard, Alexandra; Fletcher, Susan; Cooper, John; Forbes, David

2013-09-01

There is a high prevalence of psychological trauma exposure among primary care patients. General practitioners are well placed to provide appropriate support for patients coping with trauma. This article outlines an evidence-based early response to psychological trauma. Psychological first aid is the preferred approach in providing early assistance to patients who have experienced a traumatic event. General practitioners can be guided by five empirically derived principles in their early response: promoting a sense of safety, calming, self efficacy, connectedness and hope. Structured psychological interventions, including psychological debriefing, are not routinely recommended in the first few weeks following trauma exposure. General practitioner self care is an important aspect of providing post-trauma patient care.

PubMed

Aléx, Jonas; Gyllencreutz, Lina

2018-02-05

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients.

PubMed

Matsushima, Kazuhide; Goldwasser, Eleanor R; Schaefer, Eric W; Armen, Scott B; Indeck, Matthew C

2013-09-01

The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists' base specialty of training on the disparity of care process and patient outcome. We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists' base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79-2.80; P = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73-1.67; P = 0.63). Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists' base specialty of training. Copyright © 2013 Elsevier Inc. All rights reserved.

Uptake of the World Health Organization’s trauma care guidelines: a systematic review

PubMed Central

Riggle, Kevin; Joshipura, Manjul; Quansah, Robert; Reynolds, Teri; Sherr, Kenneth; Mock, Charles

2016-01-01

Abstract Objective To understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines. Methods We conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines – Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes – were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines’ implementation. Findings We identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries – 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions. Conclusion Although WHO’s trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed. PMID:27516636

Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement.

PubMed

Scott, John W; Neiman, Pooja U; Najjar, Peter A; Tsai, Thomas C; Scott, Kirstin W; Shrime, Mark G; Cutler, David M; Salim, Ali; Haider, Adil H

2017-05-01

Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using Nationwide Inpatient Sample-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. There were 145,849 patients (representing 737,852 patients nationwide) included. National inpatient trauma costs for patients aged 18 years to 64 years totaled US $14.8 billion (95% confidence interval [CI], 12.5,17.1). Preexpansion reimbursements totaled US $13.7 billion (95% CI, 10.8-14.7), yielding a national margin of -7.9% (95% CI, -10.6 to -5.1). Postexpansion projected reimbursements totaled US $15.0 billion (95% CI, 12.7-17.3), increasing the margin by 9.3 absolute percentage points to +1.4% (95% CI, -0.3 to +3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using postexpansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers' financial viability and their ability to provide care for their communities. Economic analysis, level II.

The Evolution of Military Trauma and Critical Care Medicine: Applications for Civilian Medical Care Systems

DTIC Science & Technology

2008-01-01

evidence - based medicine . Like great leaders in medicine such as Ibn Sina, war and conflict have also been credited with advances in medical and surgical therapy throughout the centuries. Like in previous conflicts, many authors note that innovations in trauma and critical care evolving from the current global war on terrorism may significantly impact civilian trauma care, critical

Trauma Healing in Refugee Camps in Guinea: A Psychosocial Program for Liberian and Sierra Leonean Survivors of Torture and War

ERIC Educational Resources Information Center

Stepakoff, Shanee; Hubbard, Jon; Katoh, Maki; Falk, Erika; Mikulu, Jean-Baptiste; Nkhoma, Potiphar; Omagwa, Yuvenalis

2006-01-01

From 1999 to 2005, the Minneapolis-based Center for Victims of Torture (CVT) served Liberian and Sierra Leonean survivors of torture and war living in the refugee camps of Guinea. A psychosocial program was developed with 3 main goals: (1) to provide mental health care; (2) to train local refugee counselors; and (3) to raise community awareness…

The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG).

PubMed

Hackworth, Jodi; Askegard-Giesmann, Johanna; Rouse, Thomas; Benneyworth, Brian

2017-05-01

Literature has shown there are significant differences between administrative databases and clinical registry data. Our objective was to compare the identification of trauma patients using All Patient Refined Diagnosis Related Groups (APR-DRG) as compared to the Trauma Registry and estimate the effects of those discrepancies on utilization. Admitted pediatric patients from 1/2012-12/2013 were abstracted from the trauma registry. The patients were linked to corresponding administrative data using the Pediatric Health Information System database at a single children's hospital. APR-DRGs referencing trauma were used to identify trauma patients. We compared variables related to utilization and diagnosis to determine the level of agreement between the two datasets. There were 1942 trauma registry patients and 980 administrative records identified with trauma-specific APR-DRG during the study period. Forty-two percent (816/1942) of registry records had an associated trauma-specific APR-DRG; 69% of registry patients requiring ICU care had trauma APR-DRGs; 73% of registry patients with head injuries had trauma APR-DRGs. Only 21% of registry patients requiring surgical management had associated trauma APR-DRGs, and 12.5% of simple fractures had associated trauma APR-DRGs. APR-DRGs appeared to only capture a fraction of the entire trauma population and it tends to be the more severely ill patients. As a result, the administrative data was not able to accurately answer hospital or operating room utilization as well as specific information on diagnosis categories regarding trauma patients. APR-DRG administrative data should not be used as the only data source for evaluating the needs of a trauma program. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effective Leadership and Management of an ACS Injury Prevention Program: Current Opinions and Perspectives From Where the Rubber Meets the Road.

PubMed

Wolfe, Elizabeth S; Bryant, Elizabeth A

The American College of Surgeons (ACS) mandates that each verified trauma center must have an injury prevention coordinator (IPC); however, Chapter 18 in the Resources for Optimal Care of the Injured Patient (2014) provides minimal information on how to effectively lead or manage an injury prevention (IP) program. This opinion article addresses 3 fundamental components of an effective IP program: (1) construction of an innovative vision of IP programming using current technology; (2) intentional investment and involvement; and (3) stakeholder leadership, engagement, and sustainability. This article also provides leadership and management methods from other professions both within and outside of the health care field that can be translated into sustainable IP program planning, implementation, and longevity.

Effectiveness of trauma team on medical resource utilization and quality of care for patients with major trauma.

PubMed

Wang, Chih-Jung; Yen, Shu-Ting; Huang, Shih-Fang; Hsu, Su-Chen; Ying, Jeremy C; Shan, Yan-Shen

2017-07-24

Trauma is one of the leading causes of death in Taiwan, and its medical expenditure escalated drastically. This study aimed to explore the effectiveness of trauma team, which was established in September 2010, on medical resource utilization and quality of care among major trauma patients. This was a retrospective study, using trauma registry data bank and inpatient medical service charge databases. Study subjects were major trauma patients admitted to a medical center in Tainan during 2009 and 2013, and was divided into case group (from January, 2011 to August, 2013) and comparison group (from January, 2009 to August, 2010). Significant reductions in several items of medical resource utilization were identified after the establishment of trauma team. In the sub-group of patients who survived to discharge, examination, radiology and operation charges declined significantly. The radiation and examination charges reduced significantly in the subcategories of ISS = 16 ~ 24 and ISS > 24 respectively. However, no significant effectiveness on quality of care was identified. The establishment of trauma team is effective in containing medical resource utilization. In order to verify the effectiveness on quality of care, extended time frame and extra study subjects are needed.

Are the paradigms in trauma disease changing?

PubMed

Alted López, E

2015-01-01

Despite an annual trauma mortality of 5 million people worldwide, resulting in countless physical disabilities and enormous expenses, there are no standardized guidelines on trauma organization and management. Over the last few decades there have been very notorious improvements in severe trauma care, though organizational and economical aspects such as research funding still need to be better engineered. Indeed, trauma lags behind other serious diseases in terms of research and organization. The rapid developments in trauma care have produced original models available for research projects, initial resuscitation protocols and radiological procedures such as CT for the initial management of trauma patients, among other advances. This progress underscores the need for a multidisciplinary approach to the initial management and follow-up of this complicated patient population, where intensivists play a major role in both the patient admission and subsequent care at the trauma unit. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Trauma and emergency surgery: an evolutionary direction for trauma surgeons.

PubMed

Scherer, Lynette A; Battistella, Felix D

2004-01-01

The success of nonoperative management of injuries has diminished the operative experience of trauma surgeons. To enhance operative experience, our trauma surgeons began caring for all general surgery emergencies. Our objective was to characterize and compare the experience of our trauma surgeons with that of our general surgeons. We reviewed records to determine case diversity, complexity, time of operation, need for intensive care unit care, and payor mix for patients treated by the trauma and emergency surgery (TES) surgeons and elective practice general surgery (ELEC) surgeons over a 1-year period. TES and ELEC surgeons performed 253 +/- 83 and 234 +/- 40 operations per surgeon, respectively (p = 0.59). TES surgeons admitted more patients and performed more after-hours operations than their ELEC colleagues. Both groups had a mix of cases that was diverse and complex. Combining the care of patients with trauma and general surgery emergencies resulted in a breadth and scope of practice for TES surgeons that compared well with that of ELEC surgeons.

The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.

PubMed

Roberts, Nicole K; Williams, Reed G; Schwind, Cathy J; Sutyak, John A; McDowell, Christopher; Griffen, David; Wall, Jarrod; Sanfey, Hilary; Chestnut, Audra; Meier, Andreas H; Wohltmann, Christopher; Clark, Ted R; Wetter, Nathan

2014-02-01

Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams. Copyright © 2014 Elsevier Inc. All rights reserved.

Taxonomy of Trauma Leadership Skills: A Framework for Leadership Training and Assessment.

PubMed

Leenstra, Nico F; Jung, Oliver C; Johnson, Addie; Wendt, Klaus W; Tulleken, Jaap E

2016-02-01

Good leadership is essential for optimal trauma team performance, and targeted training of leadership skills is necessary to achieve such leadership proficiency. To address the need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviors by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills (TTLS). Critical incident interviews were conducted with trauma team leaders and members from different specialties-emergency physicians, trauma surgeons, anesthesiologists, and emergency ward nurses-at three teaching hospitals in the Netherlands during January-June 2013. Data were iteratively analyzed for examples of excellent leadership skills at each phase of trauma care. Using the grounded theory approach, elements of excellent leadership skills were identified and classified. Elements and behavioral markers were sorted and categorized using multiple raters. In a two-round verification process in late 2013, the taxonomy was reviewed and rated by trauma team leaders and members from the multiple specialties for its coverage of essential items. Data were gathered from 28 interviews and 14 raters. The TTLS details 5 skill categories (information coordination, decision making, action coordination, communication management, and coaching and team development) and 37 skill elements. The skill elements are captured by 67 behavioral markers. The three-level taxonomy is presented according to five phases of trauma care. The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations.

What Are the Costs of Trauma Center Readiness? Defining and Standardizing Readiness Costs for Trauma Centers Statewide.

PubMed

Ashley, Dennis W; Mullins, Robert F; Dente, Christopher J; Garlow, Laura; Medeiros, Regina S; Atkins, Elizabeth V; Solomon, Gina; Abston, Dena; Ferdinand, Colville H

2017-09-01

Trauma center readiness costs are incurred to maintain essential infrastructure and capacity to provide emergent services on a 24/7 basis. These costs are not captured by traditional hospital cost accounting, and no national consensus exists on appropriate definitions for each cost. Therefore, in 2010, stakeholders from all Level I and II trauma centers developed a survey tool standardizing and defining trauma center readiness costs. The survey tool underwent minor revisions to provide further clarity, and the survey was repeated in 2013. The purpose of this study was to provide a follow-up analysis of readiness costs for Georgia's Level I and Level II trauma centers. Using the American College of Surgeons Resources for Optimal Care of the Injured Patient guidelines, four readiness cost categories were identified: Administrative, Clinical Medical Staff, Operating Room, and Education/Outreach. Through conference calls, webinars and face-to-face meetings with financial officers, trauma medical directors, and program managers from all trauma centers, standardized definitions for reporting readiness costs within each category were developed. This resulted in a survey tool for centers to report their individual readiness costs for one year. The total readiness cost for all Level I trauma centers was $34,105,318 (avg $6,821,064) and all Level II trauma centers was $20,998,019 (avg $2,333,113). Methodology to standardize and define readiness costs for all trauma centers within the state was developed. Average costs for Level I and Level II trauma centers were identified. This model may be used to help other states define and standardize their trauma readiness costs.

Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol.

PubMed

Fleet, Richard; Tounkara, Fatoumata Korika; Ouimet, Mathieu; Dupuis, Gilles; Poitras, Julien; Tanguay, Alain; Fortin, Jean Paul; Trottier, Jean-Guy; Ouellet, Jean; Lortie, Gilles; Plant, Jeff; Morris, Judy; Chauny, Jean Marc; Lauzier, François; Légaré, France

2016-04-20

Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009-2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Backward Planning a Craniomaxillofacial Trauma Curriculum for the Surgical Workforce in Low-Resource Settings.

PubMed

Shaye, David A; Tollefson, Travis; Shah, Irfan; Krishnan, Gopal; Matic, Damir; Figari, Marcelo; Lim, Thiam Chye; Aniruth, Sunil; Schubert, Warren

2018-06-06

Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education. CMF trauma surgeons representing 7 low-, middle-, and high-income countries conducted a standardized educational curriculum development program. Patient problems related to facial injuries were identified and ranked from highest to lowest morbidity. Higher morbidity problems were categorized into 4 modules with agreed upon competencies. Methods of delivery (lectures, case discussions, and practical exercises) were selected to optimize learning of each competency. A facial injuries educational curriculum (1.5 days event) was tailored to health professionals with diverse training backgrounds who care for CMF trauma patients in low-resource settings. A backward planned, competency-based curriculum was organized into four modules titled: acute (emergent), eye (periorbital injuries and sight preserving measures), mouth (dental injuries and fracture care), and soft tissue injury treatments. Four courses have been completed with pre- and post-course assessments completed. Surgeons and educators from a diverse geographic background found the backward planning curriculum development method effective in creating a competency-based facial injuries (trauma) course for health professionals in low-resource settings, where contextual aspects of shortages of surgical capacity, equipment, and emergency transportation must be considered.

A Multidisciplinary Clinical Pathway Decreases Rib Fracture-Associated Infectious Morbidity and Mortality in High-Risk Trauma Patients

DTIC Science & Technology

2006-01-01

cough. Pain was assessed during incentive spirometry or coughing using a visual analogue scale (score from 1 to 10) with failure being a score...fracture multidisciplinary clinical pathway. SIMU Surgical Intermediate Care Unit; STICU Shock Trauma Intensive Care Unit; IS incentive spirometry ...monitored bed (Surgical Intermediate Care Unit or Shock Trauma Intensive Care Unit) where they received patient-controlled analgesia and incentive

District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

PubMed

Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

2016-01-01

Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step towards improving care for the injured at district-level hospitals in LMICs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Emotional intelligence--essential for trauma nursing.

PubMed

Holbery, Natalie

2015-01-01

Patients and their relatives are increasingly considered partners in health and social care decision-making. Numerous political drivers in the UK reflect a commitment to this partnership and to improving the experience of patients and relatives in emergency care environments. As a Lecturer/Practitioner in Emergency Care I recently experienced the London Trauma System as a relative. My dual perspective, as nurse and relative, allowed me to identify a gap in the quality of care akin to emotional intelligence. This paper aims to raise awareness of emotional intelligence (EI), highlight its importance in trauma care and contribute to the development of this concept in trauma nursing and education across the globe. Copyright © 2014 Elsevier Ltd. All rights reserved.

Are severely injured trauma victims in Norway offered advanced pre-hospital care? National, retrospective, observational cohort.

PubMed

Wisborg, T; Ellensen, E N; Svege, I; Dehli, T

2017-08-01

Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. A national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured. Three trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services. A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013. © 2017 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Meeting the Mental Health Needs of Low-Income Immigrants in Primary Care: A Community Adaptation of an Evidence-Based Model

PubMed Central

Kaltman, Stacey; Pauk, Jennifer; Alter, Carol L.

2011-01-01

Low-income, uninsured immigrants are burdened by poverty and a high prevalence of trauma exposure, and thus are vulnerable to mental health problems. Disparities in access to mental health services highlight the importance of adapting evidence-based interventions in primary care settings that serve this population. In 2005, The Montgomery Cares Behavioral Health Program (MCBHP) began adapting and implementing a collaborative care model for the treatment of depression and anxiety disorders in a network of primary care clinics that serve low-income, uninsured residents of Montgomery County, Maryland, the majority of whom are immigrants. In its 6th year now, the program has generated much needed knowledge about the adaptation of this evidence-based model. The current article describes the adaptations to the traditional collaborative care model that were necessitated by patient characteristics and the clinic environment. PMID:21977940

Fresh Whole Blood Transfusion: Military and Civilian Implications.

PubMed

Goforth, Carl W; Tranberg, John W; Boyer, Phillip; Silvestri, Peter J

2016-06-01

Uncontrolled hemorrhage and exsanguination are the leading cause of preventable death, and resuscitative therapy is a critical component for survival. In various combinations, fresh whole blood, blood components, colloids, and crystalloids have all been staples of trauma care. The use of fresh whole blood is a well-established military practice that has saved the lives of thousands of American and coalition military personnel. Civilian use of fresh whole blood is far less established owing to the wide availability of individual blood components. However, this highly tailored blood supply is vulnerable to both natural and man-made disasters. In the event of such disruption, such as a major hurricane, it may be necessary for civilian hospitals to rapidly enact a fresh whole blood program. Therefore, the aim of this article is to review the current use of blood therapy for trauma resuscitation, the US military's approach to fresh whole blood, and how maintaining a civilian capacity for fresh whole blood collection in the event of future man-made and natural disasters is key to promoting survival from trauma. ©2016 American Association of Critical-Care Nurses.

Emerging technologies for pediatric and adult trauma care.

PubMed

Moulton, Steven L; Haley-Andrews, Stephanie; Mulligan, Jane

2010-06-01

Current Emergency Medical Service protocols rely on provider-directed care for evaluation, management and triage of injured patients from the field to a trauma center. New methods to quickly diagnose, support and coordinate the movement of trauma patients from the field to the most appropriate trauma center are in development. These methods will enhance trauma care and promote trauma system development. Recent advances in machine learning, statistical methods, device integration and wireless communication are giving rise to new methods for vital sign data analysis and a new generation of transport monitors. These monitors will collect and synchronize exponentially growing amounts of vital sign data with electronic patient care information. The application of advanced statistical methods to these complex clinical data sets has the potential to reveal many important physiological relationships and treatment effects. Several emerging technologies are converging to yield a new generation of smart sensors and tightly integrated transport monitors. These technologies will assist prehospital providers in quickly identifying and triaging the most severely injured children and adults to the most appropriate trauma centers. They will enable the development of real-time clinical support systems of increasing complexity, able to provide timelier, more cost-effective, autonomous care.

[Intensive care treatment of traumatic brain injury in multiple trauma patients : Decision making for complex pathophysiology].

PubMed

Trimmel, H; Herzer, G; Schöchl, H; Voelckel, W G

2017-09-01

Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients. In particular, achieving normotension in uncontrolled bleeding situations, maintenance of normocapnia in traumatic lung injury and thromboembolic prophylaxis are prone to discussion. Due to an ongoing uncertainty about the definition of normotensive blood pressure values, a cerebral perfusion pressure-guided cardiovascular management is of key importance. In contrast, there is no doubt that early goal directed coagulation management improves outcome in patients with TBI and multiple trauma. The timing of subsequent surgical interventions must be based on the development of TBI pathology; therefore, intensive care of multiple trauma patients with TBI requires an ongoing and close cooperation between intensivists and trauma surgeons in order to individualize patient care.

Concurrent chart review provides more accurate documentation and increased calculated case mix index, severity of illness, and risk of mortality.

PubMed

Frazee, Richard C; Matejicka, Anthony V; Abernathy, Stephen W; Davis, Matthew; Isbell, Travis S; Regner, Justin L; Smith, Randall W; Jupiter, Daniel C; Papaconstantinou, Harry T

2015-04-01

Case mix index (CMI) is calculated to determine the relative value assigned to a Diagnosis-Related Group. Accurate documentation of patient complications and comorbidities and major complications and comorbidities changes CMI and can affect hospital reimbursement and future pay for performance metrics. Starting in 2010, a physician panel concurrently reviewed the documentation of the trauma/acute care surgeons. Clarifications of the Centers for Medicare and Medicaid Services term-specific documentation were made by the panel, and the surgeon could incorporate or decline the clinical queries. A retrospective review of trauma/acute care inpatients was performed. The mean severity of illness, risk of mortality, and CMI from 2009 were compared with the 3 subsequent years. Mean length of stay and mean Injury Severity Score by year were listed as measures of patient acuity. Statistical analysis was performed using ANOVA and t-test, with p < 0.05 for significance. Each year demonstrated an increase in severity of illness, risk of mortality, and CMI compared with baseline values (p < 0.05). Length of stay was not significantly different, reflecting similar patient populations throughout the study. Injury Severity Score decreased in 2011 and 2012 compared with 2009, reflecting a lower level of injury in the trauma population. A concurrent documentation review significantly increases severity of illness, risk of mortality, and CMI scores in a trauma/acute care service compared with pre-program levels. These changes reflect more accurate key word documentation rather than a change in patient acuity. The increased scores might impact hospital reimbursement and more accurately stratify outcomes measures for care providers. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The big hurt: Trauma system funding in today's health care environment.

PubMed

Geehan, Douglas

2010-01-01

Trauma systems provide effective care of the injured patient but require major financial costs in readiness and availability of the extensive trauma team and specialized equipment. Traditional billing and collection practices do not fully recoup these costs. Effective use of the standard billing system is vital to the stability of a trauma system; however, a system wide funding mechanism provides an optimal, stable foundation. Efforts to provide sustainable trauma system funding are ongoing. Numerous state initiatives have been successful in funding trauma systems but a universal solution has yet to be found.

[First aid and management of multiple trauma: in-hospital trauma care].

PubMed

Boschin, Matthias; Vordemvenne, Thomas

2012-11-01

Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

Potential impact of ACA-related insurance expansion on trauma care reimbursement

PubMed Central

Scott, John W; Upadhyaya, Pooja; Najjar, Peter; Tsai, Thomas C; Scott, Kirstin W; Shrime, Mark G; Cutler, David M; Salim, Ali; Haider, Adil H

2017-01-01

Introduction Nearly one-quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. Methods We abstracted nonelderly adults (ages 18–64y) admitted for trauma from the Nationwide Inpatient Sample (NIS) during 2010—the last year prior to most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using NIS-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. Results 145,849 patients (representing 737,852 patients nationwide) were included. National inpatient trauma costs for 18–64y patients totaled $14.8 billion (95%CI:12.5,17.1). Pre-expansion reimbursements totaled $13.7 billion (10.8,14.7), yielding a national margin of −7.9% (−10.6, −5.1). Post-expansion projected reimbursements totaled $15.0 billion (12.7,17.3), increasing the margin by 9.3 absolute percentage-points to +1.4% (−0.3,+3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using post-expansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Conclusion Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers’ financial viability and their ability to provide care for their communities. Level of Evidence Level II: Sensible costs and alternatives; values obtained from limited sources; multi-way sensitivity analyses Study Type Policy Analysis / Economic Analysis PMID:28431415

Responses to birth trauma and prevalence of posttraumatic stress among Australian midwives.

PubMed

Leinweber, Julia; Creedy, Debra K; Rowe, Heather; Gamble, Jenny

2017-02-01

Midwives frequently witness traumatic birth events. Little is known about responses to birth trauma and prevalence of posttraumatic stress among Australian midwives. To assess exposure to different types of birth trauma, peritraumatic reactions and prevalence of posttraumatic stress. Members of the Australian College of Midwives completed an online survey. A standardised measure assessed posttraumatic stress symptoms. More than two-thirds of midwives (67.2%) reported having witnessed a traumatic birth event that included interpersonal care-related trauma features. Midwives recalled strong emotions during or shortly after witnessing the traumatic birth event, such as feelings of horror (74.8%) and guilt (65.3%) about what happened to the woman. Midwives who witnessed birth trauma that included care-related features were significantly more likely to recall peritraumatic distress including feelings of horror (OR=3.89, 95% CI [2.71, 5.59]) and guilt (OR=1.90, 95% CI [1.36, 2.65]) than midwives who witnessed non-interpersonal birth trauma. 17% of midwives met criteria for probable posttraumatic stress disorder (95% CI [14.2, 20.0]). Witnessing abusive care was associated with more severe posttraumatic stress than other types of trauma. Witnessing care-related birth trauma was common. Midwives experience strong emotional reactions in response to witnessing birth trauma, in particular, care-related birth trauma. Almost one-fifth of midwives met criteria for probable posttraumatic stress disorder. Midwives carry a high psychological burden related to witnessing birth trauma. Posttraumatic stress should be acknowledged as an occupational stress for midwives. The incidence of traumatic birth events experienced by women and witnessed by midwives needs to be reduced. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Women's descriptions of childbirth trauma relating to care provider actions and interactions.

PubMed

Reed, Rachel; Sharman, Rachael; Inglis, Christian

2017-01-10

Many women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women's experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes. As part of a large mixed methods study, 748 women completed an online survey and answered the question 'describe the birth trauma experience, and what you found traumatising'. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process. Four themes were identified in the data: 'prioritising the care provider's agenda'; 'disregarding embodied knowledge'; 'lies and threats'; and 'violation'. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women's own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider's clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault. Care provider actions and interactions can influence women's experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

Lessons from the Training Programme for Women with Domestic Violence Experience

ERIC Educational Resources Information Center

Anczewska, Marta; Roszczynska-Michta, Joanna; Waszkiewicz, Justyna; Charzynska, Katarzyna; Czabala, Czeslaw

2013-01-01

It is well recognized that trauma of domestic violence has destructive impact on somatic and mental health--hence quality of life. In Poland today's assistance programs provide a quite wide range of services, including emergency shelter, crisis intervention, support groups and counselling services. While health care providers may be successful at…

Fall from heights: does height really matter?

PubMed

Alizo, G; Sciarretta, J D; Gibson, S; Muertos, K; Romano, A; Davis, J; Pepe, A

2018-06-01

Fall from heights is high energy injuries and constitutes a fraction of all fall-related trauma evaluations while bearing an increase in morbidity and mortality. We hypothesize that despite advancements in trauma care, the overall survivability has not improved in this subset of trauma patients. All adult trauma patients treated after sustaining a fall from heights during a 40-month period were retrospectively reviewed. Admission demographics, clinical data, fall height (ft), injury patterns, ISS, GCS, length of stay, and mortality were reviewed. 116 patients sustained a fall from heights, 90.4% accidental. A mean age of 37± 14.7 years, 86% male, and a fall height of 19 ± 10 ft were encountered. Admission GCS was 13 ± 2 with ISS 10 ± 11. Overall LOS was 6.6 ± 14.9 days and an ICU LOS of 2.8 ± 8.9 days. Falls ≥ 25 ft.(16%) had lower GCS 10.4 ± 5.8, increased ISS 22.6 ± 13.8, a fall height 37.9 ± 13.1 ft and associated increased mortality (p < 0.001). Mortality was 5.2%, a mean distance fallen of 39 ± 22 ft. and an ISS of 31.5 ±16.5. Brain injury was the leading cause of death, 50% with open skull fractures. Level of height fallen is a good predictor of overall outcome and survival. Despite advances in trauma care, death rates remain unchanged. Safety awareness and injury prevention programs are needed to reduce the risk of high-level falls.

American Indian grand families: a qualitative study conducted with grandmothers and grandfathers who provide sole care for their grandchildren.

PubMed

Cross, Suzanne L; Day, Angelique G; Byers, Lisa G

2010-12-01

A qualitative study was conducted to determine the rationale for 31 American Indian grandparents' who provide sole care of their grandchildren, the impact of historical trauma on their decision making process in accessing services, the value of American Indian Child Welfare policies in addressing care issues, and custody status of the grand families. Indian Outreach Workers, Community Health Representatives, Elder Program Directors, and tribal community leaders were key in the recruitment of participants. The grandparents were informed of the purpose of the study and participated in face-to-face, paper and pencil, individual interviews. The subjects included 29 grandmothers and two grandfathers; age 43-86 years, with 20 who lived off reservation land and 11 who lived on reservation land in Michigan. A phenomenological approach of the "world of the lived experience" informed the design of the study. The researchers recorded the subjects' responses via field notes, conducted a comparison of responses to assess internal reliability, and entered the responses into the qualitative data analysis Nvivo program. Findings included; (1) reasons for providing sole care of grandchildren (2) stressors and rewards of providing sole care (3) grandparents decisions affected by historical traumas which focused on the boarding school issues and the removal of children from their homes due to cultural differences causing a reluctance to seek and access national and state programs (4) grandparents preference was to seek and access services provided by their Tribal Nations, and/or American Indian urban agencies (5) most lacked legal custodial status which is an indicator the grandparents' may have benefited from knowledge of the Indian Child Welfare Act (ICWA).

Medical Management and Trauma-Informed Care for Children in Foster Care.

PubMed

Schilling, Samantha; Fortin, Kristine; Forkey, Heather

2015-10-01

Children enter foster care with a myriad of exposures and experiences, which can threaten their physical and mental health and development. Expanding evidence and evolving guidelines have helped to shape the care of these children over the past two decades. These guidelines address initial health screening, comprehensive medical evaluations, and follow-up care. Information exchange, attention to exposures, and consideration of how the adversities, which lead to foster placement, can impact health is crucial. These children should be examined with a trauma lens, so that the child, caregiver, and community supports can be assisted to view their physical and behavioral health from the perspective of what we now understand about the impact of toxic stress. Health care providers can impact the health of foster children by screening for the negative health consequences of trauma, advocating for trauma-informed services, and providing trauma-informed anticipatory guidance to foster parents. By taking an organized and comprehensive approach, the health care provider can best attend to the needs of this vulnerable population. Copyright © 2015 Mosby, Inc. All rights reserved.

Emergency nursing management of the multiple trauma patient.

PubMed

Kosmos, C A

1989-01-01

This case study reinforces key principles in caring for multiply injured trauma victims. The Primary Survey is a tool developed to allow those caring for trauma patients to prioritize injuries. Those injuries identified in the Primary Survey will be the most life threatening.

Utilizing a Trauma Systems Approach to Benchmark and Improve Combat Casualty Care

DTIC Science & Technology

2010-07-01

modern battlefield utilizing evidence - based medicine . The development of injury care benchmarks enhanced the evolution of the combat casualty care performance improvement process within the trauma system.

The state of US trauma systems: public perceptions versus reality--implications for US response to terrorism and mass casualty events.

PubMed

Champion, Howard R; Mabee, Marcia S; Meredith, J Wayne

2006-12-01

Injury has long been identified as the number one killer of Americans under the age of 34, and establishment of regional trauma systems and centers incorporating primary, secondary, and tertiary care and injury-prevention strategies has proved to be a vital element in reducing injury-related sequelae, deaths, and even costs. Despite these facts, trauma system development has not been given priority for funding in many local and state governments and only intermittently at the federal level. Consequently, many of the nation's trauma centers are strapped for funds to provide emergency care to their patients. In response to a 2002 Health Resources and Services Administration (HRSA) report, which identified public support as a key element in the success of trauma system development in states and communities across the United States, a Harris Interactive study was undertaken in the fall of 2004 to determine the public's attitudes, awareness, and knowledge concerning the nature and availability of trauma care and systems of trauma care. Results of the poll were contrasted with current data on the state of US trauma systems to determine the degree of correspondence. Results of the poll indicated that fully 61% of the American public does not know that injury is the leading cause of death for those aged 1 to 34, and most believe that a trauma system is in place in every state. Almost two-thirds of the American public is confident of receiving the best medical care in the event of serious injury and would be seriously concerned if no trauma center were nearby. But only eight states have fully developed trauma systems, and most states have no federal funding or infrastructure in place for managing the aftermath of a natural disaster or terrorist event. These and other objective data reveal the mismatch between public perceptions and reality. Although almost 90% of Americans believe that state trauma systems and hospitals should have a coordinated trauma response, this has not been made a national priority. Trauma systems must be adequately developed and supported to fulfill the public's expectation to receive the best possible care if seriously injured, and to ensure readiness for mass casualty and terrorist incidents.

The American College of Surgeons Children's Surgery Verification and Quality Improvement Program: implications for anesthesiologists.

PubMed

Houck, Constance S; Deshpande, Jayant K; Flick, Randall P

2017-06-01

The Task Force for Children's Surgical Care, an ad-hoc multidisciplinary group of invited leaders in pediatric perioperative medicine, was assembled in May 2012 to consider approaches to optimize delivery of children's surgical care in today's competitive national healthcare environment. Over the subsequent 3 years, with support from the American College of Surgeons (ACS) and Children's Hospital Association (CHA), the group established principles regarding perioperative resource standards, quality improvement and safety processes, data collection, and verification that were used to develop an ACS-sponsored Children's Surgery Verification and Quality Improvement Program (ACS CSV). The voluntary ACS CSV was officially launched in January 2017 and more than 125 pediatric surgical programs have expressed interest in verification. ACS CSV-verified programs have specific requirements for pediatric anesthesia leadership, resources, and the availability of pediatric anesthesiologists or anesthesiologists with pediatric expertise to care for infants and young children. The present review outlines the history of the ACS CSV, key elements of the program, and the standards specific to pediatric anesthesiology. As with the pediatric trauma programs initiated more than 40 years ago, this program has the potential to significantly improve surgical care for infants and children in the United States and Canada.

Computer-assisted trauma care prototype.

PubMed

Holzman, T G; Griffith, A; Hunter, W G; Allen, T; Simpson, R J

1995-01-01

Each year, civilian accidental injury results in 150,000 deaths and 400,000 permanent disabilities in the United States alone. The timely creation of and access to dynamically updated trauma patient information at the point of injury is critical to improving the state of care. Such information is often non-existent, incomplete, or inaccurate, resulting in less than adequate treatment by medics and the loss of precious time by medical personnel at the hospital or battalion aid station as they attempt to reassess and treat the patient. The Trauma Care Information Management System (TCIMS) is a prototype system for facilitating information flow and patient processing decisions in the difficult circumstances of civilian and military trauma care activities. The program is jointly supported by the United States Advanced Research Projects Agency (ARPA) and a consortium of universities, medical centers, and private companies. The authors' focus has been the human-computer interface for the system. We are attempting to make TCIMS powerful in the functions it delivers to its users in the field while also making it easy to understand and operate. To develop such a usable system, an approach known as user-centered design is being followed. Medical personnel themselves are collaborating with the authors in its needs analysis, design, and evaluation. Specifically, the prototype being demonstrated was designed through observation of actual civilian trauma care episodes, military trauma care exercises onboard a hospital ship, interviews with civilian and military trauma care providers, repeated evaluation of evolving prototypes by potential users, and study of the literature on trauma care and human factors engineering. This presentation at MedInfo '95 is still another avenue for soliciting guidance from medical information system experts and users. The outcome of this process is a system that provides the functions trauma care personnel desire in a manner that can be easily and accurately used in urban, rural, and military field settings. his demonstration will focus on the user interfaces for the hand-held computer device included in TCIMS, the Field Medic Associate (FMA). The FMA prototype is a ruggedized, water-resistant personal computer, weighing approximately 5 lbs. It has an LCD graphical user interface display for patient record input and output, pen-based and audio input, audio output, and wireless communications capabilities. Automatic recording and dynamic, graphical display of time-stamped trends in patient vital signs will be simulated during the demonstration. Means for accessing existing patient record information (e.g., allergies to particular medications) and updating the record with the nature of the injury, its cause, and the treatments that were administered will be shown. These will include use of an electronic pen to mark up anatoglyphs (standard drawings of human body appearing on computer screen) to show where injuries occurred and where treatments were applied, and to input textual descriptions of the nature of the injury, its cause, what treatments were administered, etc. Computer recognition of handwritten inputs will be shown. Likewise, voice annotation and audio playback of patient record information by medics and hospital personnel will be illustrated. These latter technologies free the care providers' hands to treat the patient; they can therefore provide inputs to the patient record while information is fresh in their minds. The audio playback option allows hospital personnel to select more detailed voice annotations of specific portions of the patient record by simply touching the electronic pen to a particular place where an electronic pen marking was made by a medic in the field and then listening to the medic's corresponding audio commentary. Finally, the FMA's means for assisting the medic in simultaneously managing several injured patients will be shown. (abstract truncated)

Point-of-injury Use of Reconstituted Freeze Dried Plasma as a Resuscitative Fluid: A Special Report for Prehospital Trauma Care

DTIC Science & Technology

2013-01-01

Point-of-injury use of reconstituted freeze dried plasma as a resuscitative fluid: A special report for prehospital trauma care Elon Glassberg, MD...in- jury as part of the multidisciplinary efforts to improve trauma victims’ outcome. BACKGROUND Trauma is the leading cause of death among adults be...diabetes.1 Managing the burden of injuries from decades of wars has underscored the importance of trauma research aimed at reducing morbidity and

Trauma care systems in Saudi Arabia: an agenda for action

PubMed Central

Al-Naami, Mohammed Y.; Arafah, Maria A.; Al-Ibrahim, Fatimah S.

2010-01-01

Saudi Arabia is undergoing a rapid population growth that along with improved socioeconomics has led many individuals to own a car or even a number of cars per family, resulting in a greater number of vehicles on the roads. The reduced focus on good public transportation systems and the dependence on cars for transportation have created a diversity of drivers who are unfamiliar with the local driving rules and lack the basic skills for safe driving. This is in addition to some young drivers who frequently violate traffic laws and tend to speed most of the time. This unplanned expansion in road traffic has resulted in more car accidents, injuries, disabilities, and deaths. Accompanying that is an increased socioeconomic burden, depletion of human resources, emotional and psychological stress on families, and a strain on healthcare facilities. If this continues without prompt intervention, it will lead to increased insurance premiums and may become unmanageable. To minimize this impact, a national or regional multidisciplinary trauma system has to be developed and implemented. A trauma system is a preplanned, comprehensive, and coordinated regional injury response network that includes all facilities with the capability to care for the injured. Essential components of the system include trauma prevention, prehospital care, hospital care, rehabilitation, system administration, trauma care education and training, trauma care evaluation and quality improvement, along with the participation of society. Research has documented a significant decrease in morbidity and mortality from trauma after the implementation of such systems, depending on their efficiency. The purpose of this review is to discuss the problem of road traffic accidents in this country and address the trauma care system as an effective solution. PMID:20103958

A mindfulness intervention to reduce maternal distress in neonatal intensive care: a mixed methods pilot study.

PubMed

Mendelson, Tamar; McAfee, Ciara; Damian, April Joy; Brar, Amitoj; Donohue, Pamela; Sibinga, Erica

2018-06-05

Mothers with an infant in the neonatal intensive care unit (NICU) are at risk for depression, anxiety, and trauma symptoms, with negative implications for maternal-infant bonding, maternal well-being, and infant development. Few interventions to promote NICU mothers' mental health, however, have been developed or tested. This pre-post pilot study assessed feasibility, acceptability, and preliminary outcomes of a mindfulness intervention for NICU mothers. Twenty-seven mothers were recruited from a university NICU and offered a mindfulness intervention via introductory video and audio-recorded practices. Participants completed a baseline self-report survey. After 2 weeks of engaging with intervention materials, participants completed a second survey and in-depth interview. Quantitative data were analyzed using paired t tests; qualitative data were analyzed using thematic coding. Twenty-four women (89%) completed the study. Quantitative data indicated significant improvements in depressive, anxiety, and trauma symptoms, negative coping, NICU-related stress, and sleep (p < 0.05). Qualitative data identified themes of perceived improvements in psychological distress and stress symptoms, self-care, and relationships. Findings support the mindfulness intervention's feasibility, acceptability, and potential promise for reducing maternal distress and promoting well-being. Use of video and audio modalities may facilitate program sustainability and scale up. Further research on the program is merited.

Trauma care in German-speaking countries: have changes in the curricula led to changes in practice after 10 years?

PubMed

Kuhn-Régnier, Sarah; Stickel, Michael; Link, Björn-Christian; Fischer, Henning; Babst, Reto; Beeres, Frank J P

2018-01-06

Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur. The new curricula for surgical disciplines providing trauma care will widen this issue even further, moreover, triggered by the Anglo-American medical model. The primary aim of this study was to evaluate the current situation in German-speaking countries concerning the management of trauma patients. The interfaces between emergency physicians, orthopaedic and general surgeons have been investigated concerning the management of the trauma patients. Additionally, different future scenarios have been evaluated. An online questionnaire was submitted to members of the German Society of Trauma and Orthopaedic Surgery [Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)], including both general and orthopaedic surgeons, emergency physicians and also some members from Austria, the Netherlands and Switzerland. Questions dealt with demographic data, the current situation in the clinic of the responders in terms of management of mono- and polytrauma patients as well as fracture care. In addition, various future scenarios were evaluated. 293 members of the DGOU answered the questionnaire. The majority of the responders (45%) were orthopaedic surgeons and 34% were general trauma surgeons. Sixty-two per cent of hospitals run their emergency departments with emergency physicians. Treatment of both mono- and polytrauma patients in the emergency department is equally distributed between general and orthopaedic surgeons. Fracture care, however, is predominantly (65%) being performed by general trauma surgeons in both mono- and polytrauma patients. The majority of the respondents (80%) do not want to change the current situation and predict that in the future fracture care will still be performed by general surgeons' specialized in trauma surgery. Approximately two-thirds of the responders do not believe that emergency physicians will play a bigger role in the management of trauma patients in the future. Despite the growing importance of emergency physicians, separated in the emergency room between surgical and internal medicine fields, in the acute care of surgical patients in the emergency departments, their role in the management of the polytraumatized patients remains limited. More than 13 years after the new curricula for orthopaedic and general surgery have been implemented in Germany, fracture care is still predominantly provided by general surgeons specialized in trauma surgery. In conclusion, it seems that the general surgeon specialized in trauma surgery still plays and wants to play the key role in the management of the polytrauma patient and fracture care in German-speaking countries.

Trainees' knowledge, attitudes, and practices towards caring for the substance-exposed mother-infant dyad.

PubMed

Schiff, Davida M; Zuckerman, Barry; Wachman, Elisha M; Bair-Merritt, Megan

2017-01-01

As rates of substance use disorder during pregnancy rise, pediatric trainees are increasingly caring for infants with neonatal abstinence syndrome (NAS). This study evaluated the knowledge, attitudes, and practices of trainees caring for substance-exposed newborns and their families, comparing differences by level and type of training, and personal experience with addiction or trauma. A cross-sectional survey of medical students and pediatric, medicine/pediatric, and family medicine residents in 2015-2106. Measures included knowledge about NAS, attitudes towards mothers who use drugs, and practices around discussing addiction and trauma with families. Descriptive and bivariate analyses were conducted. The overall response rate was 70%, with 229 trainees included in the final sample (99 students, 130 residents). Fifty percent of trainees endorsed personal experience with addiction, 50% with trauma, and 35% with both addiction and trauma. Increasing years of pediatric training was associated with greater comfort in managing symptoms of NAS but decreased comfort discussing addiction and trauma. Family medicine and medicine/pediatric residents were more comfortable discussing addiction and trauma than categorical pediatric residents (P < .01). Twenty-two percent of trainees felt confident that mothers would disclose illicit drug use, 39% felt that they would actively care for their infants with NAS, and 43% felt that mothers would not make unreasonable demands. Personal experience with addiction or trauma did not significantly impact trainees' attitudes towards women with substance use disorder. Trainees may benefit from educational interventions focused on developing a 2-generational model of trauma-informed care to improve attitudes and ultimately the care of substance-exposed infants and their families.

Prehospital care for multiple trauma patients in Germany.

PubMed

Maegele, Marc

2015-01-01

For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go")toTR-DGU® certified trauma centers of the local trauma networks. Due to the difficult pre- hospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of rec- ommendations for early prehospital care for the severely injured based upon the 2011 updated multi- disciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

Saving Lives on the Battlefield (Part II) ? One Year Later A Joint Theater Trauma System and Joint Trauma System Review of Prehospital Trauma Care in Combined Joint Operations Area?Afghanistan (CJOA-A) Final Report, 30 May 2014.

PubMed

Sauer, Samual W; Robinson, John B; Smith, Michael P; Gross, Kirby R; Kotwal, Russ S; Mabry, Robert L; Butler, Frank K; Stockinger, Zsolt T; Bailey, Jeffrey A; Mavity, Mark E; Gillies, Duncan A

2015-01-01

The United States has achieved unprecedented survival rates, as high as 98%, for casualties arriving alive at the combat hospital. Our military medical personnel are rightly proud of this achievement. Commanders and Servicemembers are confident that if wounded and moved to a Role II or III medical facility, their care will be the best in the world. Combat casualty care, however, begins at the point of injury and continues through evacuation to those facilities. With up to 25% of deaths on the battlefield being potentially preventable, the prehospital environment is the next frontier for making significant further improvements in battlefield trauma care. Strict adherence to the evidence-based Tactical Combat Casualty Care (TCCC) Guidelines has been proven to reduce morbidity and mortality on the battlefield. However, full implementation across the entire force and commitment from both line and medical leadership continue to face ongoing challenges. This report on prehospital trauma in the Combined Joint Operations Area?Afghanistan (CJOA-A) is a follow-on to the one previously conducted in November 2012 and published in January 2013. Both assessments were conducted by the US Central Command (USCENTCOM) Joint Theater Trauma System (JTTS). Observations for this report were collected from December 2013 to January 2014 and were obtained directly from deployed prehospital providers, medical leaders, and combatant leaders. Significant progress has been made between these two reports with the establishment of a Prehospital Care Division within the JTTS, development of a prehospital trauma registry and weekly prehospital trauma conferences, and CJOA-A theater guidance and enforcement of prehospital documentation. Specific prehospital trauma-care achievements include expansion of transfusion capabilities forward to the point of injury, junctional tourniquets, and universal approval of tranexamic acid. 2015.

SUBSTANCE-ABUSING MOTHERS IN RESIDENTIAL TREATMENT WITH THEIR BABIES: IMPORTANCE OF PRE- AND POSTNATAL MATERNAL REFLECTIVE FUNCTIONING

PubMed Central

Pajulo, Marjukka; Pyykkönen, Nina; Kalland, Mirjam; Sinkkonen, Jari; Helenius, Hans; Punamäki, Raija-Leena; Suchman, Nancy

2012-01-01

A residential treatment program has been developed specifically for substance-abusing pregnant and parenting women in Finland, focusing on simultaneously supporting maternal abstinence from substances and the mother–baby relationship. The aims of the study are to explore maternal pre- and postnatal reflective functioning and its association with background factors, maternal exposure to trauma, and psychiatric symptoms, postnatal interaction, child development, and later child foster care placement. Participants were 34 mother–baby pairs living in three residential program units during the pre- to postnatal period. We employed self-report questionnaires on background, trauma history, and psychiatric symptoms (Brief Symptom Inventory: L.R. Derogatis, 1993; Edinburgh Postnatal Depression Scale: J.L. Cox, J.M. Holden, & R. Sagovsky, 1987; Traumatic Antecedents Questionnaire: B. Van der Kolk, 2003), videotaped mother–child interactions coded for sensitivity, control, and unresponsiveness (Care Index for Infants and Toddlers: P. Crittenden, 2003); a standardized test of child development (Bayley Scales of Infant Development-II: N. Bayley, 1993); and semistructured interviews for maternal reflective functioning (Pregnancy Interview: A. Slade, E. Bernbach, J. Grienenberger, D.W. Levy, & A. Locker, 2002; Parent Development Interview: A. Slade et al., 2005). Pre- and postnatal maternal reflective functioning (RF) was on average low, but varied considerably across participants. Average RF increased significantly during the intervention. Increase in RF level was found to be associated with type of abused substance and maternal trauma history. Mothers who showed lower postnatal RF levels relapsed to substance use more often after completing a residential treatment period, and their children were more likely to be placed in foster care. The intensive focus on maternal RF is an important direction in the development of efficacious treatment for this very high risk population. PMID:22899872

TraumaNetzwerk DGU(®): optimizing patient flow and management.

PubMed

Ruchholtz, Steffen; Lewan, Ulrike; Debus, Florian; Mand, Carsten; Siebert, Hartmut; Kühne, Christian A

2014-10-01

Caring for severely injured trauma patients is challenging for all medical professionals involved both in the preclinical and in the clinical course of treatment. While the overall quality of care in Germany is high there still are significant regional differences remaining. Reasons are geographical and infrastructural differences as well as variations in personnel and equipment of the hospitals. To improve state-wide trauma care the German Trauma Society (DGU) initiated the TraumaNetzwerk DGU(®) (TNW) project. The TNW is based on five major components: (a) Whitebook for the treatment of severely injured patients; (b) evidence-based guidelines for the medical care of severe injury; (c) local auditing of participating hospitals; (d) contract of interhospital cooperation; (d) TraumaRegister DGU(®) documentation. By the end of 2013, 644 German Trauma Centres (TC) had successfully passed the audit. To that date 44 regional TNWs with a mean of 13.5 TCs had been established and certified. The TNWs cover approximately 90% of the country's surface. Of those hospitals, 2.3 were acknowledged as Supraregional TC, 5.4 as Regional TC and 6.7 as Lokal TC. Moreover, cross border TNW in cooperation with hospitals in The Netherlands, Luxembourg, Switzerland and Austria have been established. Preparing for the audit 66% of the hospitals implemented organizational changes (e.g. TraumaRegister DGU(®) documentation and interdisciplinary guidelines), while 60% introduced personnel and 21% structural (e.g. X-ray in the ER) changes. The TraumaNetzwerk DGU(®) project combines the control of common defined standards of care for all participating hospitals (top down) and the possibility of integrating regional cooperation by forming a regional TNW (bottom up). Based on the joint approach of healthcare professionals, it is possible to structure and influence the care of severely injured patients within a nationwide trauma system. Copyright © 2014 Elsevier Ltd. All rights reserved.

Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

PubMed Central

Turgeon, Alexis F; Witteman, Holly O; Lauzier, François; Moore, Lynne; Lamontagne, François; Horsley, Tanya; Gagnon, Marie-Pierre; Droit, Arnaud; Weiss, Matthew; Tremblay, Sébastien; Lachaine, Jean; Le Sage, Natalie; Émond, Marcel; Berthelot, Simon; Plaisance, Ariane; Lapointe, Jean; Razek, Tarek; van de Belt, Tom H; Brand, Kevin; Bérubé, Mélanie; Clément, Julien; Grajales III, Francisco Jose; Eysenbach, Gunther; Kuziemsky, Craig; Friedman, Debbie; Lang, Eddy; Muscedere, John; Rizoli, Sandro; Roberts, Derek J; Scales, Damon C; Sinuff, Tasnim; Stelfox, Henry T; Gagnon, Isabelle; Chabot, Christian; Grenier, Richard; Légaré, France

2015-01-01

Background Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which stakeholders themselves will adapt evidence-based trauma care knowledge tools to their own varied institutional contexts and cultures. We will do this by developing and assessing the combined impact of WikiTrauma, a free collaborative database of clinical decision support tools, and Wiki101, a training course teaching participants how to use WikiTrauma. WikiTrauma has the potential to ensure that all stakeholders (eg, patients, clinicians, and decision makers) can all contribute to, and benefit from, evidence-based clinical knowledge about trauma care that is tailored to their own needs and clinical setting. Objective Our main objective will be to study the combined effect of WikiTrauma and Wiki101 on the quality of care in four trauma centers in Quebec. Methods First, we will pilot-test the wiki with potential users to create a version ready to test in practice. A rapid, iterative prototyping process with 15 health professionals from nonparticipating centers will allow us to identify and resolve usability issues prior to finalizing the definitive version for the interrupted time series. Second, we will conduct an interrupted time series to measure the impact of our combined intervention on the quality of care in four trauma centers that will be selected—one level I, one level II, and two level III centers. Participants will be health care professionals working in the selected trauma centers. Also, five patient representatives will be recruited to participate in the creation of knowledge tools destined for their use (eg, handouts). All participants will be invited to complete the Wiki101 training and then use, and contribute to, WikiTrauma for 12 months. The primary outcome will be the change over time of a validated, composite, performance indicator score based on 15 process performance indicators found in the Quebec Trauma Registry. Results This project was funded in November 2014 by the Canadian Medical Protective Association. We expect to start this trial in early 2015 and preliminary results should be available in June 2016. Two trauma centers have already agreed to participate and two more will be recruited in the next months. Conclusions We expect that this study will add important and unique evidence about the effectiveness, safety, and cost savings of using collaborative platforms to adapt knowledge implementation tools across jurisdictions. PMID:25699546

The effect of organized systems of trauma care on motor vehicle crash mortality.

PubMed

Nathens, A B; Jurkovich, G J; Cummings, P; Rivara, F P; Maier, R V

2000-04-19

Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes. Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System. All 50 US states and the District of Columbia. All front-seat passenger vehicle occupants aged 15 to 74 years. Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality. Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%-7%), respectively, while relaxation of state speed limits increased mortality by 7% (95% CI, 3%-10%). Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.

Orthopaedic Trauma Care Capacity Assessment and Strategic Planning in Ghana: Mapping a Way Forward.

PubMed

Stewart, Barclay T; Gyedu, Adam; Tansley, Gavin; Yeboah, Dominic; Amponsah-Manu, Forster; Mock, Charles; Labi-Addo, Wilfred; Quansah, Robert

2016-12-07

Orthopaedic conditions incur more than 52 million disability-adjusted life years annually worldwide. This burden disproportionately affects low and middle-income countries, which are least equipped to provide orthopaedic care. We aimed to assess orthopaedic capacity in Ghana, describe spatial access to orthopaedic care, and identify hospitals that would most improve access to care if their capacity was improved. Seventeen perioperative and orthopaedic trauma care-related items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with hospital staff were used to assess resource availability and factors contributing to deficiencies at 40 purposively sampled facilities. Cost-distance analyses described population-level spatial access to orthopaedic trauma care. Facilities for targeted capability improvement were identified through location-allocation modeling. Orthopaedic trauma care assessment demonstrated marked deficiencies. Some deficient resources were low cost (e.g., spinal immobilization, closed reduction capabilities, and prosthetics for amputees). Resource nonavailability resulted from several contributing factors (e.g., absence of equipment, technology breakage, lack of training). Implants were commonly prohibitively expensive. Building basic orthopaedic care capacity at 15 hospitals without such capacity would improve spatial access to basic care from 74.9% to 83.0% of the population (uncertainty interval [UI] of 81.2% to 83.6%), providing access for an additional 2,169,714 Ghanaians. The availability of several low-cost resources could be better supplied by improvements in organization and training for orthopaedic trauma care. There is a critical need to advocate and provide funding for orthopaedic resources. These initiatives might be particularly effective if aimed at hospitals that could provide care to a large proportion of the population.

Evaluation of Critical Care Monitor Technology During the US Navy Strong Angel Exercise

NASA Technical Reports Server (NTRS)

Johannesen, John; Rasbury, Jack

2003-01-01

The NASA critical path road map identifies "trauma and acute medical problems" as a clinical capability risk category (http://criticalDath.isc.nasa.gov). Specific risks include major trauma, organ laceration or contusion, hemoperitoneum, pulmonary failure, pneumo- and hemothorax, burn, open bone fracture, blunt head trauma, and penetrating injury. Mitigation of these risks includes the capability for critical care monitoring. Currently, the International Space Station (ISS) Crew Health Care System (CHeCS) does not provide such a capability. The Clinical Space Medicine Strategic Planning Forum (4/8/97), sponsored by NASA Medical Operations, identified the development of trauma care capabilities as one of the top priorities for space medicine. The Clinical Care Capability Development Project (CCCDP) subsequently undertook the task to address this need.

The Symbiosis of Combat Casualty Care and Civilian Trauma Care: 1914-2007

DTIC Science & Technology

2008-02-01

in the Korean conflict by the Army Medical Service Grad- uate School Surgical Research Team organized by Colonel William S . Stone, and in the Vietnam...PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES...NUMBER 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM( S ) 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 12

A patient education tool for nonoperative management of blunt abdominal trauma.

PubMed

Budinger, Julie Marie

2007-01-01

Blunt trauma is the primary mechanism of injury seen at Charleston Area Medical Center, a rural level I trauma center. Blunt abdominal trauma occurs as a result of various mechanisms. It can be safely managed nonoperatively and is considered to be the standard of care in hemodynamically stable patients. Appropriate patient education before discharge will enable patients to identify complications early and seek appropriate medical care.

When and Why Parents Seek Dental Care for Children under 36 Months.

PubMed

Volpato, Luiz Evaristo Ricci; Palti, Dafna Geller; Lima, Jose Eduardo de Oliveira; Machado, Maria Aparecida de Andrade Moreira; Aranha, Andreza Maria Fabio; Bandeca, Matheus Coelho; Pedro, Fabio Luis Miranda; Borges, Alvaro Henrique

2013-08-01

The aim was to analyze an infant preventive program determining at what age parents take their children for their first dental visit and the reasons why they do it. A total of 844 children aged from 0 to 36 months, enrolled in the program of oral health maintenance of the Baby Clinic, participated in this study. During the first dental visit, the parents were inquired about the reasons that led them to enroll their children in the program. One trained investigator identified this reasons on the records and classified them according to the following scores: orientation/prevention, caries treatment, malpositioned teeth, dental trauma, tooth color alterations and others. Orientation/prevention was the most prevalent reason from 0-6 months to 25-30 months of age, and at the age 30-36 months, the reason caries/treatment overcame orientation/prevention, becoming the most prevalent reason in that age group. The third place was occupied by dental trauma. The mean age parents seek for dental care to their children was 14, 92 months. This study showed a preferentially preventive/educational profile for the children. However, lots of parents still take children to the dentist preferentially for curative instead of preventive treatment. How to cite this article: Volpato LE, Palti DG, Lima JE, Machado MA, Aranha AM, Bandeca MC, Pedro FL, Borges AH. When and Why Parents Seek Dental Care for Children under 36 Months. J Int Oral Health 2013; 5(4):21-25.

Primary care management of non-English-speaking refugees who have experienced trauma: a clinical review.

PubMed

Crosby, Sondra S

2013-08-07

Refugees are a vulnerable class of immigrants who have fled their countries, typically following war, violence, or natural disaster, and who have frequently experienced trauma. In primary care, engaging refugees to develop a positive therapeutic relationship is challenging. Relative to care of other primary care patients, there are important differences in symptom evaluation and developing treatment plans. To discuss the importance of and methods for obtaining refugee trauma histories, to recognize the psychological and physical manifestations of trauma characteristic of refugees, and to explore how cultural differences and limited English proficiency affect the refugee patient-clinician relationship and how to best use interpreters. MEDLINE and the Cochrane Library were searched from 1984 to 2012. Additional citations were obtained from lists of references from select research and review articles on this topic. Engagement with a refugee patient who has experienced trauma requires an understanding of the trauma history and the trauma-related symptoms. Mental health symptoms and chronic pain are commonly experienced by refugee patients. Successful treatment requires a multidisciplinary approach that is culturally acceptable to the refugee. Refugee patients frequently have experienced trauma requiring a directed history and physical examination, facilitated by an interpreter if necessary. Intervention should be sensitive to the refugee's cultural mores.

Maximizing Academic Success for Foster Care Students: A Trauma-Informed Approach

ERIC Educational Resources Information Center

Berardi, Anna; Morton, Brenda M.

2017-01-01

Children in foster care have experienced significant trauma due to the loss of primary attachment figures and the circumstances associated with that loss. Children who have suffered trauma generally present with cognitive, social, physical, and emotional vulnerabilities. These vulnerabilities are often expressed in the P-12 academic setting…

Innovation and new trends in critical trauma disease.

PubMed

Chico-Fernández, M; Terceros-Almanza, L L; Mudarra-Reche, C C

2015-04-01

The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Prior trauma exposure and serious illness at end of life: A national study of children in the US foster care system from 2005 to 2015.

PubMed

Lindley, Lisa C; Slayter, Elspeth M

2018-06-08

Children in foster care suffer with serious illness at end of life. However, the relationship between prior trauma exposure and serious illness has received little empirical attention. The objectives were to examine the prevalence and type of trauma exposure, and investigate the relationship between prior trauma and serious illness among foster children at end of life. We used national longitudinal foster care data. We included children who were less than 18 years with residence in the United States. Serious illness (i.e., physical health, mental/behavioral health, developmental disabilities) was measured via the foster care files. Three measures of prior trauma exposure (i.e., maltreatment, drug/alcohol exposure, psychosocial stressors) were created. Using multivariate logistic regressions, we evaluated the influence of prior trauma on serious illness at end of life, while controlling for demographic, geographic, and foster care support characteristics. Sixty-eight percent of children experienced maltreatment, 28% exposure to parental drug/alcohol misuse, and 39% psychosocial stressors prior to entering foster care. Maltreatment was positively associated with physical health and developmental disabilities, while parental drug/alcohol exposure was inversely related to developmental disabilities. Psychosocial stressors contributed to the prediction of poor physical, mental, and developmental health. These findings suggest that trauma-informed end-of-life care may be a critical need among children in foster care with serious illness. Future directions are discussed, including collaboration between end-of-life clinicians and social service workers and the importance of future research to understand and improve the quality of health at end of life for this underserved population. Copyright © 2018. Published by Elsevier Inc.

The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management.

PubMed

Savel, Richard H; Cohen, Wess; Borgia, Dena; Simon, Ronald J

2018-01-01

The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a "unified adult critical care service" with the realities of the central relationship between trauma and surgical critical care.

The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

PubMed Central

Savel, Richard H.; Cohen, Wess; Borgia, Dena; Simon, Ronald J.

2018-01-01

The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care. PMID:29628674

Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma

PubMed Central

Tenenbaum, Artur; Nordeman, Lena; Sunnerhagen, Katharina S.; Gunnarsson, Ronny

2017-01-01

Objective The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma. Methods Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved. Results Women sought care later than men (p = 0.00074). Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060). There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022), indicating their injuries were at least similar to or worse than men’s. Conclusion Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men. PMID:28441465

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

PubMed Central

2018-01-01

ABSTRACT Background: Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective: To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method: Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t-tests and multiple regression. Results: Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions: There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries. PMID:29760867

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries.

PubMed

Hoysted, Claire; Babl, Franz E; Kassam-Adams, Nancy; Landolt, Markus A; Jobson, Laura; Van Der Westhuizen, Claire; Curtis, Sarah; Kharbanda, Anupam B; Lyttle, Mark D; Parri, Niccolò; Stanley, Rachel; Alisic, Eva

2018-01-01

Background : Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective : To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method : Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t -tests and multiple regression. Results : Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions : There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries.

Geographic Distribution of Trauma Burden, Mortality, and Services in the United States: Does Availability Correspond to Patient Need?

PubMed

Rios-Diaz, Arturo J; Metcalfe, David; Olufajo, Olubode A; Zogg, Cheryl K; Yorkgitis, Brian; Singh, Mansher; Haider, Adil H; Salim, Ali

2016-12-01

The association between the need for trauma care and trauma services has not been characterized previously. We compared the distribution of trauma admissions with state-level availability of trauma centers (TCs), surgical critical care (SCC) providers, and SCC fellowships, and assessed the association between trauma care provision and state-level trauma mortality. We obtained 2013 state-level data on trauma admissions, TCs, SCC providers, SCC fellowship positions, per-capita income, population size, and age-adjusted mortality rates. Normalized densities (per million population [PMP]) were calculated and generalized linear models were used to test associations between provision of trauma services (higher-level TCs, SCC providers, and SCC fellowship positions) and trauma burden, per-capita income, and age-adjusted mortality rates. There were 1,345,024 trauma admissions (4,250 PMP), 2,496 SCC providers (7.89 PMP), and 1,987 TCs across the country, of which 521 were Level I or II (1.65 PMP). There was considerable variation between the top 5 and bottom 5 states in terms of Level I/Level II TCs and SCC surgeon availability (approximately 8.0/1.0), despite showing less variation in trauma admission density (1.5/1.0). Distribution of trauma admissions was positively associated with SCC provider density and age-adjusted trauma mortality (p ≤ 0.001), and inversely associated with per-capita income (p < 0.001). Age-adjusted mortality was inversely associated with the number of SCC providers PMP. For every additional SCC provider PMP, there was a decrease of 618 deaths per year. There is an inequitable distribution of trauma services across the US. Increases in the density of SCC providers are associated with decreases in mortality. There was no association between density of trauma admissions and location of Level I/Level II TCs. In the wake of efforts to regionalize TCs, additional efforts are needed to address disparities in the provision of quality care to trauma patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Surgical care for the direct and indirect victims of violence in the eastern Democratic Republic of Congo.

PubMed

Chu, Kathryn; Havet, Philippe; Ford, Nathan; Trelles, Miguel

2010-04-14

The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. We analysed data on all surgical interventions done at Masisi district hospital between September 2007 and December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57%) of all surgical pathology and infections for another quarter (160, 14%). Trauma-related injuries accounted for only one quarter (681, 24%) of all interventions; among these, 363 (13%) were violence-related. Male gender (adjusted odds ratio (AOR) = 20.0, p < 0.001), military status (AOR = 4.1, p < 0.001), and age less than 20 years (AOR = 2.1, p < 0.001) were associated with violence-related injury. Immediate peri-operative mortality was 0.2%. In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys, to improve program planning and resource allocation and the effectiveness of the humanitarian response.

Acute care surgery: now that we have built it, will they come?

PubMed

Coleman, Jamie J; Esposito, Thomas J; Rozycki, Grace S; Feliciano, David V

2013-02-01

Concern over lack of resident interest caused by the nonoperative nature and compromised lifestyle associated with a career as a "trauma surgeon" has led to the emergence of a new acute care surgery (ACS) specialty. This study examined the opinions of current general surgical residents about training and careers in this new field. A 36-item online anonymous survey regarding ACS was sent to the program directors of 55 randomly selected general surgery (GS) training programs for distribution to their categorical residents. The national sample consisted of 1,515 PGY 1 to 5 trainees. Response rate was 45%. More than 90% of residents had an appropriate understanding of the components of ACS as generally described (trauma, surgical critical care, and emergency GS). Nearly half (46%) of all respondents have considered ACS as a career. Overall, ACS ranked as the second most appealing career ahead of surgical critical care and trauma but behind GS. Most residents believed that ACS offers better or equivalent case complexity (88%), scope of practice (84%), case volume (75%), and level of reimbursement (69%) compared with GS alone. Respondents who answered ACS had a better scope of practice (61% vs. 36%), lifestyle as an attending surgeon (77% vs. 34%), or level of reimbursement (83% vs. 38%) compared with GS were twice as likely (p < 0.0001) to have considered ACS as a career. Overall, 40% of the residents believed that ACS offers a worse lifestyle in comparison with GS. These results suggest that there is notable interest in the emerging specialty of ACS. The level of resident interest in ACS as a fellowship and career may be increased by marketing those aspects of practice, which are viewed positively and addressing negative perceptions related to lifestyle. It may be appealing to add an elective GS component to certain ACS practice options.

Trauma operating room in conjunction with an air ambulance system: indications, interventions, and outcomes.

PubMed

Law, D K; Law, J K; Brennan, R; Cleveland, H C

1982-09-01

We report a retrospective study of 198 trauma patients brought directly to a trauma operating room by an air ambulance system. Despite rapid transport, expert prehospital resuscitation, and the capability of early surgical intervention, the overall mortality was high (57%). There was no significant salvage of patients arriving without pulse, blood pressure or cardiac activity. Optimal trauma care failed to show encouraging results in this preselected group of patients with predominantly blunt and multisystem injury. The justification and cost effectiveness of this system of trauma care is discussed.

Facial trauma.

PubMed

Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

PubMed

MacDonald, Kai; Sciolla, Andrés F; Folsom, David; Bazzo, David; Searles, Chris; Moutier, Christine; Thomas, Michael L; Borton, Katherine; Norcross, Bill

2015-01-01

The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns. Copyright © 2015 Elsevier Inc. All rights reserved.

Immersion team training in a realistic environment improves team performance in trauma resuscitation.

PubMed

Siriratsivawong, Kris; Kang, Jeff; Riffenburgh, Robert; Hoang, Tuan N

2016-09-01

In the US military, it is common for health care teams to be formed ad hoc and expected to function cohesively as a unit. Poor team dynamics decreases the effectiveness of trauma care delivery. The US Navy Fleet Surgical Team Three has developed a simulation-based trauma initiative-the Shipboard Surgical Trauma Training (S2T2) Course-that emphasizes team dynamics to improve the delivery of trauma care to the severely injured patient. The S2T2 Course combines classroom didactics with hands-on simulation over a period of 6 days, culminating in a daylong, mass casualty scenario. Each resuscitation team was initially evaluated with a simulated trauma resuscitation scenario then retested on the same scenario after completing the course. A written exam was also administered individually both before and after the course. A survey was administered to assess the participants' perceived effectiveness of the course on overall team training. From the evaluation of 20 resuscitation teams made up of 123 medical personnel, there was a decrease in the mean time needed to perform the simulated trauma resuscitation, from a mean of 24.4 minutes to 13.5 minutes (P < .01), a decrease in the mean number of critical events missed, from 5.15 to 1.00 (P < .01), and a mean improvement of 41% in written test scores. More than 90% of participants rated the course as highly effective for improving team dynamics. A team-based trauma course with immersion in a realistic environment is an effective tool for improving team performance in trauma training. This approach has high potential to improve trauma care and patient outcomes. The benefits of this team-based course can be adapted to the civilian rural sector, where gaps have been identified in trauma care. Published by Elsevier Inc.

Withdrawal of care: a 10-year perspective at a Level I trauma center.

PubMed

Sise, Michael J; Sise, C Beth; Thorndike, Jonathan F; Kahl, Jessica E; Calvo, Richard Y; Shackford, Steven R

2012-05-01

Withdrawal or limitation of care (WLC) in trauma patients has not been well studied. We reviewed 10 years of deaths at our adult Level I trauma center to identify the patients undergoing WLC and to describe the process of trauma surgeon-managed WLC. This is a retrospective review of WLC. Each patient was assigned to one of three modes of WLC: care withdrawn, limited or no resuscitation, or organ harvest. Frequency, timing, and circumstances of WLC, including family involvement, ethics committee consultation, palliative care, and hospice, were reviewed. From 2000 through 2009, 375 patients died with WLC (54% of all deaths; 93% at ≥ 24 hours). For age ≥ 65 years, 80% were WLC. Overall, 15% had advance directive documents. Traumatic brain or high cervical spine injury was the cause of death in 63%. Factors associated with WLC included age, comorbidities, injury mechanism and severity, and nontrauma activation status. At time of death, 316 (84%) WLC were under trauma surgeon management. In this group, mode of WLC was care withdrawn in 74%, organ harvest in 20%, and limited or no resuscitation in 6%. Rationale for WLC in non-organ harvest patients was poor neurologic prognosis in 86% and futility in 76%. When family was identified, end-of-life discussions with physicians occurred in 100%. Conflicts over WLC occurred in 6.6% and were not associated with any demographic group. Ethics committee was involved in 2.8%. For care-withdrawn patients, median time to death from first WLC order was 6.6 hours. Palliative care and hospice consults (6% and 9%) increased yearly. WLC occurred in over 50% of all trauma deaths and exceeded 90% at ≥ 24 hours. Hospice and palliative care were increasingly important adjuncts to WLC. Guidelines for WLC should be developed to ensure quality end-of-life care for trauma patients in whom further care is futile. III, therapeutic study.

Enhanced care team response to incidents involving major trauma at night: are helicopters the answer?

PubMed

McQueen, Carl; Nutbeam, Tim; Crombie, Nick; Lecky, Fiona; Lawrence, Thomas; Hathaway, Karen; Wheaton, Steve

2015-07-01

Challenges exist in how to deliver enhanced care to patients suffering severe injury in geographically remote areas within regionalised trauma networks at night. The physician led Enhanced Care Teams (ECTs) in the West Midlands region of England do not currently utilise helicopters to respond to incidents at night. This study describes this remote trauma workload at night within the regional network in terms of incident location; injury profile and patient care needs and discusses various solutions to the delivery of ECTs to such incidents, including the need for helicopter based platforms. We present a retrospective analysis of incidents involving Major Trauma occurring in the West Midlands Regional Trauma Network in England over a one year period (1st April 2012 until the 31st March 2013). Anonymised patient records from the Trauma Audit and Research Network (TARN) for patients that had been conveyed to hospital by ambulance/air ambulance were cross-referenced with the West Midlands Ambulance Service NHS Foundation Trust (WMAS) Computer Assisted Dispatch (CAD) archive for the same period. Data were abstracted from the combined dataset relating to injury severity (ISS/ICU admission/death at scene or as inpatient); ECT resource activations/scene attendances; incident location and the need for enhanced level care. A total of 603 incidents involving Major Trauma were identified during night time hours. Enhanced Care Team resources attended scene in 167 cases (27.7%). Of the incidents not attended by an ECT 179 (41.1%) were due to falls and 91 (20.9%) involved a 'Road Traffic Collision'. A total of 36 incidents (6.0% of total at night) occurred in locations identified as being greater than 45min by road from the nearest major trauma centre. In these cases 13 patients had enhanced care needs that could not be addressed at scene by the attending ambulance service personnel. There is limited evidence to support the need for night HEMS operations in the West Midlands regional trauma network. The potential role of night HEMS in other regional trauma networks in England requires further evaluation with specific reference to the incidence of Major Trauma and efficiency of existing road based systems. Copyright © 2015. Published by Elsevier Ltd.

Child Maltreatment, Trauma, and Physical Health Outcomes: The Role of Abuse Type and Placement Moves on Health Conditions and Service Use for Youth in Foster Care.

PubMed

Jackson, Yo; Cushing, Christopher C; Gabrielli, Joy; Fleming, Kandace; O'Connor, Bridget M; Huffhines, Lindsay

2016-01-01

The purpose of the study was to investigate the relations between abuse types, non-maltreatment-related trauma, and health service utilization in a sample of youth in foster care with and without chronic medical conditions. A total of 213 youth, aged 8-21 years, provided self-report of general trauma and abuse exposure. Medicaid claims for each child were collected from official state databases. Exposure to sexual abuse, neglect, or general trauma but not exposure to physical abuse or psychological abuse increased the rates of medical visits, while only general trauma increased medical hospitalizations.  Trauma types are not equally predictive of health care utilization for youth with chronic health conditions. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of injury severity in patients with major trauma.

PubMed

Stanford, Penelope; Booth, Nicola; Suckley, Janet; Twelvetree, Timothy; Thomas, Debbie

2016-08-03

Major trauma centres provide specialised care for patients who have experienced serious traumatic injury. This article provides information about major trauma centres and outlines the assessment tools used in this setting. Since patients in major trauma centres will be transferred to other settings, including inpatient wards and primary care, this article is relevant for both nurses working in major trauma centres and in these areas. Traumatic injuries require rapid assessment to ensure the patient receives prompt, adequate and appropriate treatment. A range of assessment tools are available to assist nurses in major trauma centres and emergency care to assess the severity of a patient's injury. The most commonly used tools are triage, Catastrophic Haemorrhage Airway to Exposure assessment, pain assessment and the Glasgow Coma Scale. This article summarises the use of these assessment tools in these settings, and discusses the use of the Injury Severity Score (ISS) to determine the severity of patient injuries.

A statewide model program to improve emergency department readiness for pediatric care.

PubMed

Cichon, Mark E; Fuchs, Susan; Lyons, Evelyn; Leonard, Daniel

2009-08-01

Pediatric emergency patients have unique needs, requiring specialized personnel, training, equipment, supplies, and medications. Deficiencies in these areas have resulted in historically poorer outcomes for pediatric patients versus adults. Since 1985, federally funded Emergency Medical Services for Children (EMSC) programs in each state have been working to improve the quality of pediatric emergency care. The Health Resources and Services Administration now requires that all EMSC grantees report on specific performance measures. This includes implementation of a standardized system recognizing hospitals that are able to stabilize or manage pediatric medical emergencies and trauma cases. We describe the steps involved in implementing Illinois' 3-level facility recognition process to illustrate a model that other states might use to provide appropriate pediatric care and comply with new Health Resources and Services Administration performance measures.

A model to advance nursing science in trauma practice and injury outcomes research.

PubMed

Richmond, Therese S; Aitken, Leanne M

2011-12-01

This discussion paper reports development of a model to advance nursing science and practice in trauma care based on an analysis of the literature and expert opinion. The continuum of clinical care provided to trauma patients extends from the time of injury through to long-term recovery and final outcomes. Nurses bring a unique expertise to meet the complex physical and psychosocial needs of trauma patients and their families to influence outcomes across this entire continuum. Literature was obtained by searching CINAHL, PubMed and OvidMedline databases for 1990-2010. Search terms included trauma, nursing, scope of practice and role, with results restricted to those published in English. Manual searches of relevant journals and websites were undertaken. Core concepts in this trauma outcomes model include environment, person/family, structured care settings, long-term outcomes and nursing interventions. The relationships between each of these concepts extend across all phases of care. Intermediate outcomes are achieved in each phase of care and influence and have congruence with long-term outcomes. Implications for policy and practice.  This model is intended to provide a framework to assist trauma nurses and researchers to consider the injured person in the context of the social, economic, cultural and physical environment from which they come and the long-term goals that each person has during recovery. The entire model requires testing in research and assessment of its practical contribution to practice. Planning and integrating care across the trauma continuum and recognition of the role of the injured person's background, family and resources will lead to improved long-term outcomes. © 2011 Blackwell Publishing Ltd.

Radiation dose from initial trauma assessment and resuscitation: review of the literature.

PubMed

Hui, Catherine M; MacGregor, John H; Tien, Homer C; Kortbeek, John B

2009-04-01

Trauma care benefits from the use of imaging technologies. Trauma patients and trauma team members are exposed to radiation during the continuum of care. Knowledge of exposure amounts and effects are important for trauma team members. We performed a review of the published literature; keywords included "trauma," "patients," "trauma team members," "wounds," "injuries," "radiation," "exposure," "dose" and "computed tomography" (CT). We also reviewed the Board on Radiation Effects Research (BEIR VII) report, published in 2005 and 2006. We found no randomized controlled trials or studies. Relevant studies demonstrated that CT accounts for the single largest radiation exposure in trauma patients. Exposure to 100 mSv could result in a solid organ cancer or leukemia in 1 of 100 people. Trauma team members do not exceed the acceptable occupation radiation exposure determined by the National Council of Radiation Protection and Management. Modern imaging technologies such as 16- and 64-slice CT scanners may decrease radiation exposure. Multiple injured trauma patients receive a substantial dose of radiation. Radiation exposure is cumulative. The low individual risk of cancer becomes a greater public health issue when multiplied by a large number of examinations. Though CT scans are an invaluable resource and are becoming more easily accessible, they should not replace careful clinical examination and should be used only in appropriate patients.

Prehospital care training in a rapidly developing economy: a multi-institutional study.

PubMed

Vyas, Dinesh; Hollis, Michael; Abraham, Rohit; Rustagi, Neeti; Chandra, Siddharth; Malhotra, Ajai; Rajpurohit, Vikas; Purohit, Harshada; Pal, Ranabir

2016-06-01

The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality. An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels. Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur. These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise. Published by Elsevier Inc.

Spine Trauma as a Component of Essential Neurosurgery: An Outcomes Analysis from Cambodia.

PubMed

Chua, Michelle H; Hong, Raksmey; Rydeth, Tytim; Vycheth, Iv; Nang, Sam; Vuthy, Din; Park, Kee B

2018-06-01

In recent years, delivery of cost-effective "essential neurosurgery" in resource-limited communities has been recognized as an indispensable part of health care and a global health priority. The aim of this study was to review outcomes from operative management of spine trauma at a resource-limited government hospital in Phnom Penh, Cambodia, and to provide an epidemiologic report to guide prevention programs. A retrospective review of a prospective neurosurgical database was performed to identify risk factors for spine trauma and severe spinal cord injury (American Spinal Injury Association A or American Spinal Injury Association B) and to evaluate the cost-effectiveness of surgery for patients treated at Preah Kossamak Hospital for subaxial and thoracolumbar spine trauma from 2013 to 2016. Surgical treatment was provided to 277 patients with cervical or thoracolumbar spine trauma, including 36 facet dislocations and 135 thoracolumbar burst fractures at a cost of $100-$280 per surgery. Six patients (2.2%) required treatment for postoperative wound infection. Reoperation was performed in 8 patients (2.9%) for wrong-level surgery. Failure of short-segment pedicle screw fixation was discovered in 4 patients (7.0%). Neurologic improvement was reported by 64 patients (65.3%) with incomplete spinal cord injury and available long-term follow-up. Affordable neurosurgical care can be provided in a safe and sustainable manner to patients with traumatic spine and spinal cord injuries in resource-limited communities. This supports the call for essential neurosurgery to be made available around the world to individuals from all socioeconomic strata. Copyright © 2018 Elsevier Inc. All rights reserved.

Leveraging Trauma Lessons from War to Win in a Complex Global Environment.

PubMed

Remick, Kyle N

2016-01-01

The US military has made great strides in combat casualty care since 2001. As the Army concludes combat operations in Iraq and Afghanistan, it faces new operational challenges in trauma care. The military medical community must stay ahead of the curve through sustaining current investments in combat casualty care research. This article describes lessons learned at war from a Joint Trauma System perspective in order to place in context how we should proceed in order to provide optimal care for our Warfighters in the future.

Prior Trauma Exposure for Youth in Treatment Foster Care

ERIC Educational Resources Information Center

Dorsey, Shannon; Burns, Barbara J.; Southerland, Dannia G.; Cox, Julia Revillion; Wagner, H. Ryan; Farmer, Elizabeth M. Z.

2012-01-01

Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and…

Responding with Care to Students Facing Trauma

ERIC Educational Resources Information Center

Souers, Kristin

2018-01-01

Exposure to trauma--which many experts view as include ongoing life stressors like poverty, parents divorcing, death of a family member, or drug abuse in the home--is prevalent among school-aged children. Teachers know that facing trauma impedes students' ability to focus and learn, but it can be challenging to keep responding caringly to a…

Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma.

PubMed

Kohrt, Brandon A; Hruschka, Daniel J

2010-06-01

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.

The Combat Medic Aid Bag: 2025. CoTCCC Top 10 Recommended Battlefield Trauma Care Research, Development, and Evaluation Priorities for 2015.

PubMed

Butler, Frank K; Blackbourne, Lorne H; Gross, Kirby

2015-01-01

While the list presented here is by no means a comprehensive list of all of the research areas of interest in battlefield trauma care, much less a list of research needs across the entire continuum of combat casualty care, it does provide the collective judgment of the CoTCCC about the highest priorities for RDT&E that relate to battlefield trauma care. Two additional observations should be made regarding that point: (1) As the landmark Eastridge et al. 2012 study convincingly documented, most combat fatalities occur in the prehospital phase of care, so research efforts that enable Combat medics, corpsmen, and PJs to care for their casualties more effectively will convey the highest probability of further reducing the case fatality rate and preventable deaths among US Combat casualties; and (2) inasmuch as the mission of the CoTCCC is to update the TCCC Guidelines as needed, this group has excellent visibility of the most important current research questions in battlefield trauma care.

Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey.

PubMed

Kristiansen, Thomas; Ringdal, Kjetil G; Skotheimsvik, Tarjei; Salthammer, Halvor K; Gaarder, Christine; Naess, Pål A; Lossius, Hans M

2012-01-26

Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance.Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations. A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations. Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams. Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention.

The impact of inpatient palliative care on end of life care among older trauma patients who die after hospital discharge.

PubMed

Lilley, Elizabeth J; Lee, Katherine C; Scott, John W; Krumrei, Nicole J; Haider, Adil H; Salim, Ali; Gupta, Rajan; Cooper, Zara

2018-05-30

Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission. A non-PC control group was developed by exact-matching for age, comorbidity, admission year, injury severity, length of stay, and post-discharge survival. We employed logistic regression to evaluate six EOL care outcomes: discharge to hospice, rehospitalization, skilled nursing facility (SNF) or long-term acute care hospital (LTACH) admission, death in an institutional setting, and intensive care unit (ICU) admission or receipt of life-sustaining treatments (LST) during a subsequent hospitalization. Of 294,665 patients who died within 180 days after discharge, 2.1% received inpatient PC. Among 5,693 matched pairs, inpatient PC was associated with increased odds of discharge to hospice (odds ratio [95% confidence interval] = 3.80 [3.54-4.09]) and reduced odds of rehospitalization (0.17[0.15-0.20]), SNF/LTACH admission (0.43[0.39-0.47]), death in an institutional setting (0.34[0.30-0.39]), subsequent ICU admission (0.51[0.36-0.72]), or receiving LST (0.56[0.39-0.80]). Inpatient palliative care is associated with lower intensity and less burdensome EOL care in the geriatric trauma population. Nonetheless, it remains underutilized among those who die within 6 months after discharge. Level III STUDY TYPE: Prognostic.

Point-of-care ultrasonography by pediatric emergency medicine physicians.

PubMed

Marin, Jennifer R; Lewiss, Resa E

2015-04-01

Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews. Copyright © 2015 by the American Academy of Pediatrics.

Treatment of liver injuries at level I and level II centers in a multi-institutional metropolitan trauma system. The Midwest Trauma Society Liver Trauma Study Group.

PubMed

Helling, T S; Morse, G; McNabney, W K; Beggs, C W; Behrends, S H; Hutton-Rotert, K; Johnson, D J; Reardon, T M; Roling, J; Scheve, J; Shinkle, J; Webb, J M; Watkins, M

1997-06-01

The development of trauma systems and trauma centers has had a major impact on the fate of the critically injured patient. However, some have suggested that care may be compromised if too many trauma centers are designated for a given area. As of 1987, the state of Missouri had designated six adult trauma centers, two Level I and four Level II, for the metropolitan Kansas City, Mo, area, serving a population of approximately 1 million people. To determine whether care was comparable between the Level I and II centers, we conducted a concurrent evaluation of the fate of patients with a sentinel injury, hepatic trauma, over a 6-year period (1987-1992) who were treated at these six trauma centers. All patients during the 6-year study period who suffered liver trauma and who survived long enough to be evaluated by computerized tomography or celiotomy were entered into the study. Patients with central nervous system trauma were excluded from analysis. Information concerning mechanism of injury, RTS, Injury Severity Score (ISS), presence of shock, liver injury scoring, mode of treatment, mortality, and length of stay were recorded on abstract forms for analysis. Care was evaluated by mortality, time to the operating room (OR), and intensive care unit (ICU) and hospital length of stay. Over the 6-year period 300 patients with non-central nervous system liver trauma were seen. Level I centers cared for 195 patients and Level II centers cared for 105. There was no difference in mean ISS or ISS > 25 between Level I and II centers. Fifty-five (28%) patients arrived in shock at Level I centers and 24 (23%) at Level II centers. Forty-eight patients (16%) died. Thirty-two (16%) died at Level I centers, and 16 (15%) died at Level II centers. Twenty of 55 patients (36%) in shock died at Level I centers, and 11 of 24 (46%) died at Level II centers (p = 0.428). Forty-three patients (22%) had liver scaling scores of IV-VI at Level I centers, and 10 (10%) had similar scores at Level II centers (p < 0.01). With liver scores IV-VI, 22 of 43 (51%) died at Level I centers and 10 of 14 (71%) died at Level II centers (p = 0.184). There was no difference in mean time or in delays beyond 1 hour to the OR for those patients in shock between Level I and II centers. There was a longer ICU stay at Level II centers (5.0 +/- 8.3 vs. 2.8 +/- 8.4 days, p = 0.04). This difference was confined to penetrating injuries. There was no difference in hospital length of stay. In a metropolitan trauma system, when Level I and II centers were compared for their ability to care for victims of hepatic trauma, there was no discernible difference in care rendered with respect to severity of injury, mortality, delays to the OR, or hospital length of stay. It was observed that more severe liver injuries were seen at Level I centers, but this did not seem to significantly affect care at Level II centers. There was a longer ICU stay observed at Level II centers owing to penetrating injuries, possibly because there were fewer penetrating injuries treated at these facilities. Although the bulk of patients were seen at Level I centers, care throughout the system was equivalent.

Trauma related to falls from trees treated in a specialized trauma centre in Burkina-Faso-one hundred and six cases treated in one year.

PubMed

Dakouré, Patrick W H; Diallo, Malick; Traoré, André-Charles V; Gandéma, Salifou; Barro, Sie Drissa; Traoré, Ibrahim Alain; Zaré, Cyprien

2015-12-01

Falls from trees related traumas are rarely reported in literature. They are public health problems in developing countries where their frequency is still important. The aim of the study is to describe falls from trees related trauma patterns and to present preventative measures. An annual ongoing prospective study was held in our trauma emergency department (ED) about all the patients who sustained an injury after a recent fall from tree. A questionnaire related to the patient and to the trauma was established. The data were encoded and analysed by a statistical software. One hundred six patients who sustained a fall from tree trauma, out of a total of 139, were studied. Most patients were under 15 years old (76.4 %); they were injured in fruits season (33 %) after a fall from a fruit tree (mango trees, Shea trees, Néré, etc.) and were received late (86 %). Injuries were polymorphic from traumatic brain injuries (51.8 %) and spine injuries (13.2 %) to thoraco-abdominal (21.6 %) and limbs injuries (46.2 %). Three housewives were pregnant at the time of the trauma with secondary abortions. Patients were managed medically (33.9 %), surgically (19.8 %) or by casting (34.9 %) with good outcome in 59 cases. Twelve patients refused medical care and two died. Education programs must focus on picking fruits and leaves in order to make them safe and prevent injuries related to these traditional or professional activities.

Blood Component Therapy in Trauma Guided with the Utilization of the Perfusionist and Thromboelastography

PubMed Central

Walsh, Mark; Thomas, Scott G.; Howard, Janet C.; Evans, Edward; Guyer, Kirk; Medvecz, Andrew; Swearingen, Andrew; Navari, Rudolph M.; Ploplis, Victoria; Castellino, Francis J.

2011-01-01

Abstract: 25–35% of all seriously injured multiple trauma patients are coagulopathic upon arrival to the emergency department, and therefore early diagnosis and intervention on this subset of patients is important. In addition to standard plasma based tests of coagulation, the thromboelastogram (TEG®) has resurfaced as an ideal test in the trauma population to help guide the clinician in the administration of blood components in a goal directed fashion. We describe how thromboelastographic analysis is used to assist in the management of trauma patients with coagulopathies presenting to the emergency department, in surgery, and in the postoperative period. Indications for the utilization of the TEG® and platelet mapping as point of care testing that can guide blood component therapy in a goal directed fashion in the trauma population are presented with emphasis on the more common reasons such as massive transfusion protocol, the management of traumatic brain injury with bleeding, the diagnosis and management of trauma in patients on platelet antagonists, the utilization of recombinant FVIIa, and the management of coagulopathy in terminal trauma patients in preparation for organ donation. The TEG® allows for judicious and protocol assisted utilization of blood components in a setting that has recently gained acceptance. In our program, the inclusion of the perfusionist with expertise in performing and interpreting TEG® analysis allows the multidisciplinary trauma team to more effectively manage blood products and resuscitation in this population. PMID:22164456

Addressing Trauma Among Women With Serious Addictive Disorders: Treatment Models, Program Factors, And Potential Mediators

PubMed Central

Nayak, Madhabika B.; Blacksher, Susan

2009-01-01

A large majority of women entering addiction treatment present significant symptoms of trauma related to physical or sexual abuse. Despite research indicating that trauma interventions are integral to women’s successful recovery from addiction, many programs do not adequately address violence-related trauma. This chapter provides a review of the literature on trauma among women with addictive disorders and several manual based interventions developed to address co-occurring addiction and trauma-related disorders. One intervention, “Beyond Trauma,” which has become increasingly popular among community based programs is described in detail. Beyond Trauma appears to have several advantages over other therapies for treating trauma and addiction in women, including 1) a theoretical foundation that draws on relational theory as a guide to the intervention, 2) a broad based approach that can be utilized by a variety of professional and paraprofessional staff members, 3) a focus that goes beyond treating women with a formal diagnosis of post traumatic stress disorder to include treatment for an array of symptoms and problems associated with trauma, and 4) gender-appropriate use of expressive arts in its curriculum. The chapter also discusses treatment program environment factors that may be critically important to treatment outcome for women: 1) whether the program is gender specific, 2) the degree of emphasis on peer involvement in recovery, 3) program recognition of the value of knowledge-based recovery experience, 4) program facilitation of cohesion, 5) the empowerment of clients in decisions affecting the program and 6) skills training relevant to managing moods, relationships and a variety of problems that women face during recovery. Possible mechanisms of change for Beyond Trauma are explored with particular emphasis on the variety of ways the intervention attempts to impact problem areas experienced by women (e.g., mental health functioning self esteem and social support). Recommendations for future research in the treatment of trauma and addiction-related disorders in women are outlined. PMID:24348202

Annual Trauma Anesthesia and Critical Care Symposium (5th) Held in Amsterdam, The Netherlands on 11-12 June 1992

DTIC Science & Technology

1992-10-01

Variations in the Role of the TA/CCS A. The Trauma Team: Leader vs. Member B. Pain Management C. Teacher/Trainer D. Critical Care Transport E... Pain Management Interested individuals should send CV and request for application to: David P. Tarantino, M.D. Director of Education MIEMSS...Supportive Treatment Strategy? Interpleural Regional Analgesia in the Pain Management of Chest Trauma Airway Management with Penetrating Neck Trauma

Nonoperative Management of Splenic Injury in Combat: 2002-2012

DTIC Science & Technology

2015-03-01

recognized as the defini- tive treatment for splenic injury when Dr. Johnston reported 150 splenectomies for trauma in 1908.4 However, in 1968, Upadhyaya...management safe and effective for all splenic blunt trauma ? A systematic review. Crit Care 2013; 17(5): R185. 6. Joint Theater Trauma System Clinical Practice...2014. 7. Zonies D, Eastridge B: Combat management of splenic injury: trends during a decade of conflict. J Trauma Acute Care Surg 2012; 73(2 Suppl 1

Person-Centered Care for Older Adults With Serious Mental Illness and Substance Misuse Within a Program of All-Inclusive Care for the Elderly.

PubMed

Cacchione, Pamela Z; Eible, Lisa; Gill, Le'Roi L; Huege, Steven F

2016-05-01

Providing person-centered care (PCC) to older adults with dual diagnosis, co-occurring serious mental illness (SMI), and substance misuse is complex and requires an interprofessional team. Older adults, who qualify for both Medicaid and Medicare (i.e., dual-eligibles) are overrepresented in the population of older adults with SMI and substance misuse. Programs of All-Inclusive Care for the Elderly (PACE) exist to support community living needs of nursing home-eligible older adults and are increasingly in a position to serve older adults with SMI and substance misuse issues. PACE programs provide integrated person-centered mental health care to address the serious medical, social, and emotional complications posed by having SMI and substance misuse disorders. The case study presented illustrates PCC provided to a dual-diagnosis PACE participant, illustrating the impact of recent and past trauma on current psychopathology and substance misuse. Finally, recommendations for addressing PCC of dual diagnosis within the PACE model are provided. [Journal of Gerontological Nursing, 42(5), 11-17.]. Copyright 2016, SLACK Incorporated.

Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices.

PubMed

Beckett, Andrew; Pelletier, Pierre; Mamczak, Christiaan; Benfield, Rodd; Elster, Eric

2012-12-01

Multidisciplinary trauma care systems have been shown to improve patient outcomes. Medical care in support of the global war on terror has provided opportunities to refine these systems. We report on the multidisciplinary trauma care system at the Role III Hospital at Kandahar Airfield, Afghanistan. We reviewed the Joint Trauma System Registry, Kandahar database from 1 October 2009 to 31 December 2010 and extracted data regarding patient demographics, clinical variables and outcomes. We also queried the operating room records from 1 January 2009 to 31 December 2010. In the study period of 1 October 2009 to 31 December 2010, 2599 patients presented to the trauma bay, with the most common source of injury being from Improvised Explosive Device (IED) blasts (915), followed by gunshot wounds (GSW) (327). Importantly, 19 patients with triple amputations as a result of injuries from IEDs were seen. 127 patients were massively transfused. The in-hospital mortality was 4.45%. From 1 January 2010 to 31 December 2010, 4106.24 operating room hours were logged to complete 1914 patient cases. The mean number of procedures per case in 2009 was 1.27, compared to 3.11 in 2010. Multinational, multidisciplinary care is required for the large number of severely injured patients seen at Kandahar Airfield. Multidisciplinary trauma care in Kandahar is effective and can be readily employed in combat hospitals in Afghanistan and serve as a model for civilian centres. Published by Elsevier Ltd.

Adapting to the changing paradigm of management of colon injuries.

PubMed

Woo, Karen; Wilson, Matthew T; Killeen, Kelly; Margulies, Daniel R

2007-12-01

Based on the evolution that the management of colonic trauma has undergone since the early 1990s, we hypothesized that the use of diversion has decreased at our institution over the last decade. A retrospective review was performed of all patients who presented to our trauma center with colon injuries between 1995 and 2006. A total of 81 patients were analyzed. Twenty-five patients (31%) were treated with diversion and 56 patients (69%) underwent primary repair or resection with anastomosis. The rate of diversion in the first half of the study period as well as the second half of the study period was 31%. There was no difference in the complication rates. The usage of diversion remains higher than current literature would indicate. As a result, we are implementing a program that will actively encourage our trauma surgeons to improve the quality of patient care by incorporating evidence-based medicine into clinical practice.

Implementing screening, brief intervention, and referral for alcohol and drug use: the trauma service perspective.

PubMed

Sise, Michael J; Sise, C Beth; Kelley, Dorothy M; Simmons, Charles W; Kelso, Dennis J

2005-09-01

Most trauma surgeons are unfamiliar with screening, brief intervention, and referral (SBIR) programs for substance use disorders, and few trauma centers provide them. This report describes how an urban private-teaching hospital adapted a protocol from an existing emergency department-based program to include patients treated by the trauma service. We recorded the rates of SBIR completion and reasons for failure during each phase of the implementation, interviewed trauma service staff and health educators to assess attitudes toward the program, and evaluated patient satisfaction surveys. By adding SBIR staff to the trauma outpatient clinic and to trauma morning rounds, the capture rate increased from 12 to 71%. Most screened patients (59%) were found at risk for problems or probably dependent on alcohol or drugs. Trauma service staff and health educators reported high satisfaction with the program. Patients reported higher satisfaction with SBIR. SBIR services can be effectively integrated into all components of a busy, urban trauma service by adding specially trained health educators to the trauma service staff. This collaboration provides effective SBIR services to both trauma and emergency service patients without interfering with patient flow or medical procedures. The relatively high percentage of patients at risk for alcohol or drug problems supports the inclusion of routine alcohol and drug screening for all eligible trauma patients.

Strategic Planning for Research in Pediatric Critical Care.

PubMed

Tamburro, Robert F; Jenkins, Tammara L; Kochanek, Patrick M

2016-11-01

To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Expert opinion expressed during the Strategic Planning Conference. Not applicable. Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. Common themes and suggested priorities were identified and coalesced. Of the many pathophysiologic conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the interrelationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded transdisciplinary and multiprofessional collaboration and diversity representation.

Strategic Planning for Research in Pediatric Critical Care

PubMed Central

Tamburro, Robert F.; Jenkins, Tammara L.; Kochanek, Patrick M.

2016-01-01

Objective To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Data Sources Expert opinion expressed during the Strategic Planning Conference. Study Selection Not applicable Data Extraction Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. Data Synthesis Common themes and suggested priorities were identified and coalesced. Conclusions Of the many pathophysiological conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the inter-relationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded transdisciplinary and multiprofessional collaboration and diversity representation. PMID:27679964

A systematic approach to very important person preparedness for a trauma center.

PubMed

Bulson, Julie; Mattice, Connie; Bulson, Timothy

2012-01-01

Hospitals across the United States are more involved in disaster/rapid response planning than ever. This collaboration is often driven by continuing federal and state preparedness and all-hazards planning efforts that provide cooperative agreement and/or grant support. These efforts currently include programs administered by the US assistant secretary for preparedness and response, the US Centers for Disease Control and Prevention, the US Department of Defense, and the US Department of Homeland Security. Beyond legislated support or mandates, key emergency management regulations governing hospital-specific disaster planning and response activities are required of hospitals by The Joint Commission, the largest national hospital accrediting body. Despite this ongoing, heightened awareness and inclusion of health care in local and regional emergency response planning, there is 1 partnership to yet strengthen: the relationship between community trauma centers and US Secret Service staff responsible for White House travel and health care contingency plans. One Michigan hospital system designed a program that has made preevent communications and preparedness for rapid very important person response with the Secret Service as important as other local all-hazards planning; the evolution of this partnership is the focus of this article.

Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part II: Specific injuries and ED management.

PubMed

Rothrock, S G; Green, S M; Morgan, R

2000-06-01

Evaluation of children with suspected abdominal trauma could be a difficult task. Unique anatomic and physiologic features render vital sign assessment and the physical examination less useful than in the adult population. Awareness of injury patterns and associations will improve the early diagnosis of abdominal trauma. Clinicians must have a complete understanding of common and atypical presentations of children with significant abdominal injuries. Knowledge of the utility and limitations of available laboratory and radiologic adjuncts will assist in accurately identifying abdominal injury. While other obvious injuries (eg, facial, cranial, and extremity trauma) can distract physicians from less obvious abdominal trauma, an algorithmic approach to evaluating and managing children with multisystem trauma will improve overall care and help to identify and treat abdominal injuries in a timely fashion. Finally, physicians must be aware of the capabilities of their own facility to handle pediatric trauma. Protocols must be in place for expediting the transfer of children who require a higher level of care. Knowledge of each of these areas will help to improve the overall care and outcome of children with abdominal trauma.

The "TRAUMA LIFE" initiative: The impact of a multidisciplinary checklist process on outcomes and communication in a Trauma Intensive Care Unit.

PubMed

Joseph, Kimberly; Gupta, Sameer; Yon, James; Partida, Renee; Cartagena, Lee; Kubasiak, John; Buie, Vanessa; Miller, Jared; Wiley, Dorion; Nagy, Kimberly; Starr, Frederic; Dennis, Andrew; Kaminsky, Matthew; Bokhari, Faran

2018-03-09

Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. "TRAUMA LIFE" was considered maturely implemented by 2016. Multiple quality metrics, including restraint order compliance, were compared between 2013 and 2016 (pre- and post-implementation). Compliance with the "Family Message" (FM), a part of the "TRAUMA LIFE" communication process, was analyzed in 2016. Improvement was seen in CAUTI, VAE, and IUCU; CLABSI rates increased. Restraint order compliance increased significantly. FM delivery compliance was inconsistent; improvement was noted in concordance between update content and FM documented in Electronic Medical Record. Implementation of "TRAUMA LIFE" was well integrated into the rounding process and was associated with some improvement in quality metrics and communication. Additional evaluation is required to assess sustainability. Copyright © 2018 Elsevier Inc. All rights reserved.

Trauma-Informed Care for Children in the Child Welfare System: An Initial Evaluation of a Trauma-Informed Parenting Workshop.

PubMed

Sullivan, Kelly M; Murray, Kathryn J; Ake, George S

2016-05-01

An essential but often overlooked component to promoting trauma-informed care within the child welfare system is educating and empowering foster, adoptive, and kinship caregivers (resource parents) with a trauma-informed perspective to use in their parenting as well as when advocating for services for their child. In this first evaluation of the National Child Traumatic Stress Network's trauma-informed parenting workshop (Caring for Children who Have Experienced Trauma, also known as the Resource Parent Curriculum), participant acceptance and satisfaction and changes in caregiver knowledge and beliefs related to trauma-informed parenting were examined. Data from 159 ethnically diverse resource parents were collected before and after they participated in the workshop. Results demonstrate that kinship and nonkinship caregivers showed significant increases in their knowledge of trauma-informed parenting and their perceived self-efficacy parenting a child who experienced trauma. Nonkinship caregivers increased on their willingness to tolerate difficult child behaviors, whereas kinship caregivers did not show a significant change. Participants also demonstrated high levels of satisfaction with the workshop. Although these preliminary results are important as the first empirical study supporting the workshop's effectiveness, the limitations of this study and the directions for future research are discussed. © The Author(s) 2015.

Coagulation management in trauma-associated coagulopathy: allogenic blood products versus coagulation factor concentrates in trauma care.

PubMed

Klages, Matthias; Zacharowski, Kai; Weber, Christian Friedrich

2016-04-01

Coagulation management by transfusion of allogenic blood products and coagulation factors are competing concepts in current trauma care. Rapid and adequate therapy of trauma-associated coagulopathy is crucial to survival of severely injured patients. Standard coagulation tests such as prothrombin time and activated partial thromboplastin time are commonly used, but these tests are inappropriate for monitoring and guiding therapy in trauma patients. Coagulation factor-based treatment showed promising results, but randomized trials have not yet been performed. In addition, viscoelastic tests are needed to guide therapy, although there is in fact limited evidence for these in tests in trauma care. Regarding transfusion therapy with allogenic blood products, plasma transfusion has been associated with improved survival in trauma patients following massive transfusion. In contrast, patients not requiring massive transfusion seem to be at risk for suffering complications with increasing volumes of plasma transfused. The collective of trauma patients is heterogeneous. Despite the lack of evidence, there are strong arguments for individualized patient treatment with coagulation factors for some indications and to abstain from the use of fresh frozen plasma. In patients with severe trauma and major bleeding, plasma, platelets, and red blood cells should be considered to be administered at a ratio of 1 : 1 : 1.

Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial.

PubMed

Albers, Leah L; Sedler, Kay D; Bedrick, Edward J; Teaf, Dusty; Peralta, Patricia

2005-01-01

Genital tract trauma after spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations.

Midwifery Care Measures in the Second Stage of Labor and Reduction of Genital Tract Trauma at Birth: A Randomized Trial

PubMed Central

Albers, Leah L.; Sedler, Kay D.; Bedrick, Edward J.; Teaf, Dusty; Peralta, Patricia

2005-01-01

Genital tract trauma following spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified, beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to one of three care measures late in the second stage of labor:1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant’s head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques based on maternal comfort and other considerations. PMID:16154062

Multiple trauma in children: critical care overview.

PubMed

Wetzel, Randall C; Burns, R Cartland

2002-11-01

Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

Infectious Complications of Noncombat Trauma Patients Provided Care at a Military Trauma Center

DTIC Science & Technology

2010-05-01

complication~ and risk factors of noncombat trauma patients cared for in a military le,·ell trauma center with an a\\sociated burn unit u~ing the... risk factors for infection, and since the combat tnjured population is generally without serious comorbidities, MTLITARY MEDICINE, Vol. 175, M ay 20...wound infection’> were most common in the JTTR. Risk factors for in fection seen 1n the BAMC TR more closely reflected those reported in other studies

Digital health technology and trauma: development of an app to standardize care.

PubMed

Hsu, Jeremy M

2015-04-01

Standardized practice results in less variation, therefore reducing errors and improving outcome. Optimal trauma care is achieved through standardization, as is evidenced by the widespread adoption of the Advanced Trauma Life Support approach. The challenge for an individual institution is how does one educate and promulgate these standardized processes widely and efficiently? In today's world, digital health technology must be considered in the process. The aim of this study was to describe the process of developing an app, which includes standardized trauma algorithms. The objective of the app was to allow easy, real-time access to trauma algorithms, and therefore reduce omissions/errors. A set of trauma algorithms, relevant to the local setting, was derived from the best available evidence. After obtaining grant funding, a collaborative endeavour was undertaken with an external specialist app developing company. The process required 6 months to translate the existing trauma algorithms into an app. The app contains 32 separate trauma algorithms, formatted as a single-page flow diagram. It utilizes specific smartphone features such as 'pinch to zoom', jump-words and pop-ups to allow rapid access to the desired information. Improvements in trauma care outcomes result from reducing variation. By incorporating digital health technology, a trauma app has been developed, allowing easy and intuitive access to evidenced-based algorithms. © 2015 Royal Australasian College of Surgeons.

Utilization and intensity of outpatient care related to military sexual trauma for veterans from Afghanistan and Iraq.

PubMed

Turchik, Jessica A; Pavao, Joanne; Hyun, Jenny; Mark, Hanna; Kimerling, Rachel

2012-07-01

Little research has examined factors associated with the utilization of outpatient health care services related to sexual assault experiences. The Veterans Health Administration provides free outpatient treatment services to veterans who report military sexual trauma (MST); this system provides a unique opportunity to examine factors related to the utilization of mental health and non-mental health outpatient services by patients with sexual trauma. The current study examined sociodemographic, military service factors, and primary diagnoses related to utilization and utilization intensity of MST-related care among 4,458 Operation Enduring Freedom/Operation Iraqi Freedom Veterans in a 1-year period after reporting an experience of MST. Of the veterans who reported MST, 75.9% received MST-related care. The most notable factor that influenced receipt and intensity of MST-related care was gender, where male veterans used less care than female veterans. These results have important treatment implications for both veteran and civilian sexual trauma survivors.

The mortality risk from motor vehicle injuries in California has increased during the last decade.

PubMed

Waxman, Kenneth; Izfar, Seema; Grotts, Jonathan

2012-09-01

Organized trauma systems and trauma centers are thought to improve trauma outcomes. It is clear that injured patients who receive care in trauma centers have survival advantages. However, large regions of California still do not have access to trauma centers. Many injured patients in California continue to receive their care in nontrauma center hospitals. The purpose of this study was to compare outcomes in California counties with and without trauma centers. In addition, we wished to query the efficacy of the current statewide trauma system by asking whether mortality after motor vehicle trauma in California has improved during the last decade. We performed a retrospective outcome study. The California highway patrol provided data from all motor vehicle crashes (MVCs) and mortality during the years 1999 to 2008 for the 58 counties in California. Percent fatality was calculated as the number of motor vehicle fatalities divided by the number of injuries. Data were analyzed to compare outcomes in counties with and without trauma centers. Furthermore, demographic data were studied to analyze the relationship of population and hospital density on mortality. Mortality was significantly lower in counties with trauma centers. Low population and hospital density independently correlated with increased mortality. Injury mortality rates after MVCs increased during the decade both in counties with and without trauma centers. Overall, the presence of a trauma center improved the chances of survival after an MVC in California counties. However, mortality rates after injuries increased during the decade both in counties with and without trauma centers. Future efforts to improve outcomes for injured patients in California will require new approaches, which must include improving both access to trauma centers and the care provided in nontrauma center hospitals. Epidemiologic study, level III.

Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey

PubMed Central

2012-01-01

Background Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance. Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations. Methods A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations. Results Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams. Conclusion Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention. PMID:22281020

Financial implications of nonoperative fracture care at an academic trauma center.

PubMed

Appleton, Paul; Chacko, Aron; Rodriguez, Edward K

2012-11-01

To determine if nonoperative fracture Current Procedural Technology codes generate a significant portion of annual revenues in an academic practice. Retrospective review of an orthopaedic trauma practice billings during fiscal year 2008. An urban level-1 trauma center. Outpatient clinic, and all consults, to the orthopaedic trauma service in the emergency room and hospital wards staffed by an attending traumatologist. An analysis was made of relative value units (RVUs) generated by operative and nonoperative care, separating the later into clinic, consults, and closed (nonoperative) fracture treatment. A total of 19,815 RVUs were generated by the trauma service during the 2008 fiscal year. Emergency department and ward consults generated 2176 (11%) of RVUs, whereas outpatient clinic generated an additional 1313 (7%) of RVUs. Nonoperative (closed) fracture care generated 2725 (14%) RVUs, whereas surgical procedures were responsible for the remaining 13,490 (68%) of RVUs. In terms of overall financial reimbursement, nonoperative management, consults, and office visits generated 31% of income for the trauma service. Although the largest financial contribution to a busy surgical practice is operative procedures, 1 must not overlook the important impact of nonoperative fracture care and consults. In our academic center, nearly one-third of all income was generated from nonsurgical procedures. In the current medical/financial climate, 1 must be diligent in optimizing the finances of trauma care to sustain an economically viable practice. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A model for identifying and ranking need for trauma service in nonmetropolitan regions based on injury risk and access to services.

PubMed

Schuurman, Nadine; Bell, Nathaniel; Hameed, Morad S; Simons, Richard

2008-07-01

Timely access to definitive trauma care has been shown to improve survival rates after severe injury. Unfortunately, despite development of sophisticated trauma systems, prompt, definitive trauma care remains unavailable to over 50 million North Americans, particularly in rural areas. Measures to quantify social and geographic isolation may provide important insights for the development of health policy aimed at reducing the burden of injury and improving access to trauma care in presently under serviced populations. Indices of social deprivation based on census data, and spatial analyses of access to trauma centers based on street network files were combined into a single index, the Population Isolation Vulnerability Amplifier (PIVA) to characterize vulnerability to trauma in socioeconomically and geographically diverse rural and urban communities across British Columbia. Regions with a sufficient core population that are more than one hour travel time from existing services were ranked based on their level of socioeconomic vulnerability. Ten regions throughout the province were identified as most in need of trauma services based on population, isolation and vulnerability. Likewise, 10 communities were classified as some of the least isolated areas and were simultaneously classified as least vulnerable populations in province. The model was verified using trauma services utilization data from the British Columbia Trauma Registry. These data indicate that including vulnerability in the model provided superior results to running the model based only on population and road travel time. Using the PIVA model we have shown that across Census Urban Areas there are wide variations in population dependence on and distances to accredited tertiary/district trauma centers throughout British Columbia. Many of the factors that influence access to definitive trauma care can be combined into a single quantifiable model that researchers in the health sector can use to predict where to place new services. The model can also be used to locate optimal locations for any basket of health services.

Military sexual trauma among homeless veterans.

PubMed

Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel

2013-07-01

Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in providing mental health care to homeless Veterans.

Contextualizing the Trauma Experience of Women Immigrants From Central America, South America, and Mexico

PubMed Central

Kaltman, Stacey; de Mendoza, Alejandra Hurtado; Gonzales, Felisa A.; Serrano, Adriana; Guarnaccia, Peter J.

2012-01-01

Trauma has been understudied among Latina immigrants from Central and South America. This study examined the types and context of trauma exposure experienced by immigrant women from Central America, South America, and Mexico living in the United States. Twenty-eight women seeking care in primary care or social service settings completed life history interviews. The majority of the women reported some type of trauma exposure in their countries of origin, during immigration, and/or in the United States. In the interviews, we identified types of trauma important to the experience of these immigrants that are not queried by trauma assessments typically used in the United States. We also identified factors that are likely to amplify the impact of trauma exposure. The study highlights the importance of utilizing a contextualized approach when assessing trauma exposure among immigrant women. PMID:22144133

Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis: A prospective observational study of two centers.

PubMed

Shackford, Steven R; Cipolle, Mark D; Badiee, Jayraan; Mosby, Danielle L; Knudson, M Margaret; Lewis, Paul R; McDonald, Victoria S; Olson, Erik J; Thompson, Kimberly A; Van Gent, Jan-Michael; Zander, Ashley L

2016-05-01

Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in trauma. Controversy exists regarding the use of lower extremity duplex ultrasound screening and surveillance (LEDUS). Advocates cite earlier diagnosis and treatment of deep venous thrombosis (DVT) to prevent clot propagation and pulmonary embolism (PE). Opponents argue that LEDUS identifies more DVT (surveillance bias) but does not reduce the incidence of PE. We sought to determine the magnitude of surveillance bias associated with LEDUS and test the hypothesis that LEDUS does not decrease the incidence of PE after injury. We compared data from two Level 1 trauma centers: Scripps Mercy Hospital, which used serial LEDUS, and Christiana Care Health System, which used LEDUS only for symptomatic patients. Beginning in 2013, both centers prospectively collected data on demographics, injury severity, and VTE risk for patients admitted for more than 48 hours. Both centers used mechanical and pharmacologic prophylaxis based on VTE risk assessment. Scripps Mercy treated 772 patients and Christiana Care treated 454 patients with similar injury severity and VTE risk. The incidence of PE was 0.4% at both centers. The odds of a DVT diagnosis were 5.3 times higher (odds ratio, 5.3; 95% confidence interval, 2.5-12.9; p < 0.0001) for patients admitted to Scripps Mercy than for patients admitted to Christiana Care. Of the 80 patients who developed DVT, PE, or both, 99% received prophylaxis before the event. Among those who received pharmacologic prophylaxis, the VTE rates between the two centers were not statistically significantly different (Scripps Mercy, 11% vs. Christiana Care, 3%; p = 0.06). The odds of a diagnosis of DVT are increased significantly when a program of LEDUS is used in trauma patients. Neither pharmacologic prophylaxis nor mechanical prophylaxis is completely effective in preventing VTE in trauma patients. VTE should not be considered a "never event" in this cohort. Prognostic/epidemiologic study, level III; therapeutic study, level III.

Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial.

PubMed

Häske, David; Beckers, Stefan K; Hofmann, Marzellus; Lefering, Rolf; Grützner, Paul A; Stöckle, Ulrich; Papathanassiou, Vassilios; Münzberg, Matthias

2017-08-14

Prehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective training. Standardized courses, like PHTLS, are established for health care professionals to improve the prehospital care of trauma patients. The aim of the study was to investigate the subjective safety in prehospital trauma care and learning progress by paramedics in a longitudinal analysis. This was a prospective intervention trial and part of the mixed-method longitudinal EPPTC-trial, evaluating subjective and objective changes among participants and real patient care as a result of PHTLS courses. Participants were evaluated with pre/post questionnaires as well as one year after the course. We included 236 datasets. In the pre/post comparison, an increased performance could be observed in nearly all cases. The result shows that the expectations of the participants of the course were fully met even after one year (p = 0.002). The subjective safety in trauma care is significantly better even one year after the course (p < 0.001). Regression analysis showed that (ABCDE)-structure is decisive (p = 0.036) as well as safety in rare and common skills (both p < 0.001). Most skills are also rated better after one year. Knowledge and specific safety are assessed as worse after one year. The courses meet the expectations of the participants and increase the subjective safety in the prehospital care of trauma patients. ABCDE-structure and safety in skills are crucial. In the short term, both safety in skills and knowledge can be increased, but the courses do not have the power to maintain knowledge and specific subjective safety issues over a year. German Clinical Trials Register, ID DRKS00004713 , registered 14. February 2014.

Geriatric trauma.

PubMed

Adams, Sasha D; Holcomb, John B

2015-12-01

The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

The Association between the Working Alliance with Adolescent Girls in Residential Care and Their Trauma-Related Symptoms in Emerging Adulthood

ERIC Educational Resources Information Center

Ayotte, Marie-Hélène; Lanctôt, Nadine; Tourigny, Marc

2017-01-01

Background: Until now, the relations between the working alliance and trauma-related symptoms have received little or no study in residential-care settings. However, considering the high prevalence of past experiences of interpersonal trauma among young people in residential centers, it is essential to examine this issue more closely. Objective:…

Impact of Trauma-Informed Care Professional Development on School Personnel Perceptions of Knowledge, Dispositions, and Behaviors toward Traumatized Students

ERIC Educational Resources Information Center

Goodwin-Glick, Kelly L.

2017-01-01

Childhood trauma is prevalent and has a profound impact on student learning, behaviors, social-emotional well-being (Perfect et al., 2016), physical health, relationships (Tishelman et al., 2010), and brain architecture (Perry, 2001). Trauma-informed care professional development (PD) within the school setting is a relatively new notion for school…

Level-I Trauma Center Effects on Return-to-Work Outcomes

ERIC Educational Resources Information Center

Prada, Sergio I.; Salkever, David; MacKenzie, Ellen J.

2012-01-01

Background: Injury is the leading cause of death for persons aged 1-44 years in the United States. Injuries have a substantial economic cost. For that reason, regional systems of trauma care in which the more acutely injured patients are transported to Level-I (L-I) trauma centers (TCs) has been widely advocated. However, the cost of TC care is…

Visceral trauma: principles of management and role of embolotherapy.

PubMed

Stratil, Peter G; Burdick, Thomas R

2008-09-01

Interventional radiology for the treatment of traumatic visceral hemorrhage has emerged as an important adjunct to modern trauma care. This article outlines the general surgical concepts of the acute care of trauma patients as a guideline for catheter-based therapy. Specific considerations are presented for embolizing visceral injuries in the liver, spleen, and kidney. Expected outcomes and follow-up are reviewed.

Function of "nontrauma" surgeons in level I trauma centers in the United States.

PubMed

Pate, J W

1997-06-01

Although the general "trauma" surgeon is usually the team leader in level I trauma centers, the use of surgical subspecialists and nonsurgeons is frequently ill-defined. This study was done to gain data in regard to actual use of subspecialists in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by telephone cells. Second, records of 400 consecutive patients at the Elvis Presley Trauma Center were reviewed to determine the use of subspecialists during the first 24 hours of care of individual patients. There were differences in the use of surgical subspecialists and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and attending of inpatients. Consultation "guidelines" are used for many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of each patient. Problems exist in many centers regarding the use of subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as admitting and attending physicians of trauma patients.

Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.

PubMed

Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N; Thompson, Laura; Evans, David C; Boulger, Creagh T; Caterino, Jeffrey M

2015-01-01

We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Trauma research in Qatar: a literature review and discussion of progress after establishment of a trauma research centre.

PubMed

El-Menyar, A; Asim, M; Zarour, A; Abdelrahman, H; Peralta, R; Parchani, A; Al-Thani, H

2016-02-01

A structured research programme is one of the main pillars of a trauma care system. Despite the high rate of injury-related mortalities, especially road traffic accidents, in Qatar, little consideration has been given to research in trauma. This review aimed to analyse research publications on the subject of trauma published from Qatar and to discuss the progress of clinical research in Qatar and the Gulf Cooperation Council countries with special emphasis on trauma research. A literature search using PubMed and Google Scholar search engines located 757 English-language articles within the fields of internal medicine, surgery and trauma originating from Qatar between the years 1993 and 2013. A steep increase in the number of trauma publications since 2010 could be linked to the setting up of a trauma research centre in Qatar in 2011. We believe that establishing a research unit has made a major impact on research productivity, which ultimately benefits health care.

Scoring systems of severity in patients with multiple trauma.

PubMed

Rapsang, Amy Grace; Shyam, Devajit Chowlek

2015-04-01

Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Current Status of Postdoctoral and Graduate Programs in Dentistry.

PubMed

Assael, Leon

2017-08-01

Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Paying it forward: Four-year analysis of the Eastern Association for the Surgery of Trauma Mentoring Program.

PubMed

Zakrison, Tanya L; Polk, Travis M; Dixon, Rachel; Ekeh, Akpofure P; Gross, Kirby R; Davis, Kimberly A; Kurek, Stanley J; Stassen, Nicole A; Patel, Mayur B

2017-07-01

Mentorship programs in surgery are used to overcome barriers to clinical and academic productivity, research success, and work-life balance. We sought to determine if the Eastern Association for the Surgery of Trauma (EAST) Mentoring Program has met its goals of fostering academic and personal growth in young acute care surgeons. We conducted a systematic program evaluation of EAST Mentoring Program's first 4 years. Demographic information was collected from EAST records, mentorship program applications, and mentee-mentor career development plans. We reviewed the career development plans for thematic commonalities and results of a structured, online questionnaire distributed since program inception. A mixed methods approach was used to better understand the program goals from both mentee and mentor perspectives, as well as attitudes and barriers regarding the perceived success of this career development program. During 2012 to 2015, 65 mentoring dyads were paired and 60 completed the program. Of 184 surveys distributed, 108 were returned (57% response rate). Respondents were evenly distributed between mentees and mentors (53 vs. 55, p = 0.768). In participant surveys, mentoring relationships were viewed to focus on research (45%), "sticky situations" (e.g., communication, work-life balance) (27%), education (18%), or administrative issues (10%). Mentees were more focused on research and education versus mentors (74% vs. 50%; p = 0.040). Mentees felt that goals were "always" or "usually" met versus mentors (89% vs. 77%; p = 0.096). Two barriers to successful mentorship included time and communication, with most pairs communicating by email. Most respondents (91%) planned to continue the relationship beyond the EAST Mentoring Program and recommended the experience to colleagues. Mentee satisfaction with the EAST Mentoring Program was high. Mentoring is a beneficial tool to promote success among EAST's young members, but differences exist between mentee and mentor perceptions. Revising communication expectations and time commitment to improve career development may help our young acute care surgeons.

Experience with 161 cases of anterior exposure of the thoracic and lumbar spine in an acute care surgery model: impact of exposure level and underlying pathology on morbidity.

PubMed

Seoudi, Hani; Laporta, Matthew; Griffen, Margaret; Rizzo, Anne; Pullarkat, Ranjit

2013-08-15

Retrospective chart review. To evaluate the outcomes of anterior exposure of the thoracic and lumbar spine by an acute care surgery service. Spine surgeons typically require an "approach surgeon" to provide anterior exposure of the thoracic and lumbar spine. We hypothesized that a dedicated acute care surgery service can perform those operations with acceptable morbidity and mortality. A retrospective review of 161 trauma and nontrauma patients was performed. All cases were performed at a level I trauma center with a dedicated acute care surgery service. In-hospital morbidity and mortality were evaluated. A brief description of the operative techniques used by our group is also provided. Of the 161 patients, 59 (37%) were trauma patients. Ninety-three patients (58%) had anterolateral retroperitoneal exposure of the thoracic and lumbar spine. Sixty-eight patients (42%) had anterior retroperitoneal midline exposure of the lumbar and lumbosacral spine. Total morbidity was 9.3% (7.4% for trauma patients and 1.8% for non trauma patients). Morbidity was highest in patients who had anterolateral exposure of the thoracic and lumbar spine (6.8%). Morbidity in patients who had midline exposure of L4 to S1 was 0%. Total mortality was 1.2% (3.3% for trauma patients and 0% for nontrauma patients). The acute care surgery service gained 3141 physician work relative value units (RVU) by performing those operations. Anterior exposure of the thoracic and lumbar spine both for trauma and nontrauma related indications can be performed with acceptable morbidity and mortality by a dedicated acute care surgery service. Morbidity and mortality were higher in trauma patients and in those who underwent thoracolumbar procedures. Patients who had midline exposure of L4 to S1 for degenerative disc disease had the lowest morbidity. 4.

Forward Surgical Team Experience (FSTE) Is Associated With Increased Confidence With Combat Surgeon Trauma Skills.

PubMed

Mancini, D Joshua; Smith, Brian P; Polk, Travis M; Schwab, C William

2018-05-08

Little is known regarding the confidence of military surgeons prior to combat zone deployment. Military surgeons are frequently deployed without peers experienced in combat surgery. We hypothesized that forward surgical team experience (FSTE) increases surgeon confidence with critical skill sets. We conducted a national survey of military affiliated personnel. We used a novel survey instrument that was piloted and validated by experienced military surgeons to collect demographics, education, practice patterns, and confidence parameters for trauma and surgical critical care skills. Skills were defined as crucial operative techniques for hemorrhage control and resuscitation. Surveyors were blinded to participants, and surveys were returned electronically via REDCap database. Data were analyzed with SPSS using appropriate models. Significance was considered p < 0.05. Of 174 distributed surveys, 86 were completed. Nine individuals failed to characterize their FSTE, thus leaving a sample size of 77. At the time of first deployment, 78.4% were alone or with less experienced surgeons and 53.2% had less than 2 yr of post-residency practice. The respondents' confidence in damage control techniques and seven other trauma skills increased relative to FSTE. After adjusting for years of practice, number of trauma resuscitations performed per month and pre-deployment training, there remained a significant positive association between FSTE and confidence in damage control, thoracic surgery, extremity/junctional hemorrhage control, trauma systems administration, adult critical care and airway management. Training programs and years of general surgery practice do not replace FSTE among military surgeons. Pre-deployment training that mimics FST skill sets should be developed to improve military surgeon confidence and outcomes. Prognostic and Epidemiologic, Level IV.

Audit filters for improving processes of care and clinical outcomes in trauma systems.

PubMed

Evans, Christopher; Howes, Daniel; Pickett, William; Dagnone, Luigi

2009-10-07

Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness. To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems. Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009. We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an intervention for improving processes of care, morbidity, or mortality for severely injured patients. Two authors independently screened the search results, applied inclusion criteria, and extracted data. There were no studies identified that met the inclusion criteria for this review. We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.

Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology, and Ethnophysiology in Alleviating Suffering and Preventing Stigma

PubMed Central

Hruschka, Daniel J.

2013-01-01

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder (PTSD) treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multi-faceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact upon the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters, and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry. PMID:20309724

Update on prehospital emergency care of severe trauma patients.

PubMed

Tazarourte, K; Cesaréo, E; Sapir, D; Atchabahian, A; Tourtier, J-P; Briole, N; Vigué, B

2013-01-01

The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center ("trauma center") reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible. Medical dispatching plays a major role in determining patient care. The establishment of a hospital care network is an important issue that is not formalized enough in France. The initial triage of severe trauma patients must be improved to avoid taking patients to hospitals that are not equipped to take care of them. For this purpose, the MGAP score can predict severity and help decide where to transport the patient. However, it does not help predict the need for urgent resuscitation procedures. Hemodynamic management is central to the care of hemorrhagic shock and severe head trauma. Transport helicopter with a physician on board has an important role to allow direct admission to a specialized center in geographical areas that are difficult to access. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Trauma in Auckland: an overview.

PubMed

Streat, S J; Donaldson, M L; Judson, J A

1987-07-22

Data are presented on all 569 subjects who, as a result of trauma, either died or were admitted to hospital in Auckland over a four week period. Median age was 23 with an overall 3:2 male:female ratio. Median injury severity score (ISS) was five with 9% of subjects having an ISS of 16 or more (major trauma). Blunt trauma accounted for 84% of all injuries. Life threatening injuries were most commonly to the head, thorax and abdomen while the largest number of less severe injuries were to the extremities. Eight subjects died before admission to hospital and a further six in hospital. Definitive care was given to 98% of patients at Middlemore and Auckland hospitals (including the onsite Princess Mary paediatric facility) but 26% had presented first to other hospitals and 43% of all patients were transferred from one hospital to another. The 561 patients used 6380 hospital days (including 314 intensive care days) and the following services--operating room 63%, orthopaedic ward 45%, plastic surgical ward 17%, paediatric ward 15%, neurosurgical ward 10%, general surgical ward 5%, intensive care 5% and CT scanner 4%. Only one hospital death was judged potentially preventable. This study reveals areas where trauma care could be improved, demonstrates the large amount of hospital resources required to treat trauma and particularly highlights the urgent need for studies into strategies for trauma prevention in New Zealand.

Assessing the academic and professional needs of trauma nurse practitioners and physician assistants.

PubMed

Wilson, Laurie N; Wainwright, Gail A; Stehly, Christy D; Stoltzfus, Jill; Hoff, William S

2013-01-01

Because of multiple changes in the health care environment, the use of services of physician assistants (PAs) and nurse practitioners (NPs) in trauma and critical care has expanded. Appropriate training and ongoing professional development for these providers are essential to optimize clinical outcomes. This study offers a baseline assessment of the academic and professional needs of the contemporary trauma PAs/NPs in the United States. A 14-question electronic survey, using SurveyMonkey, was distributed to PAs/NPs at trauma centers identified through the American College of Surgeons Web site and other online resources. Demographic questions included trauma center level, provider type, level of education, and professional affiliations. Likert scale questions were incorporated to assess level of mentorship, comfort level with training, and individual perceived needs for academic and professional development. There were 120 survey respondents: 60 NPs and 60 PAs. Sixty-two respondents (52%) worked at level I trauma centers and 95 (79%) were hospital-employed. Nearly half (49%) reported working in trauma centers for 3 years or less. One hundred nineteen respondents (99%) acknowledged the importance of trauma-specific education; 98 (82%) were required by their institution to obtain such training. Thirty-five respondents (32%) reported receiving $1000 per year or less as a continuing medical education benefit. Insufficient mentorship, professional development, and academic development were identified by 22 (18%), 16 (13%), and 30 (25%) respondents, respectively. Opportunities to network with trauma PAs/NPs outside their home institution were identified as insufficient by 79 (66%). While PAs/NPs in trauma centers recognize the importance of continued contemporary trauma care and evidence-based practices, attending trauma-related education is not universally required by their employers. Financial restrictions may pose an additional impediment to academic development. Therefore, resource-efficient opportunities should be a prime consideration for advanced practitioners education, especially since half of the reported workforce has 3 years or less experience. The Eastern Association of Trauma and other organizations can provide an ideal venue for mentorship, academic development, and networking that is vital to PA/NP professional development and, ultimately, quality patient care.

Norwegian trauma team leaders - training and experience: A national point prevalence study

PubMed Central

2011-01-01

Background The treatment of trauma victims is a complex multi-professional task in a stressful environment. We previously found that trauma team members perceive leadership as the most important human factor. The aim of the present study was to assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs. Methods We conducted an anonymous descriptive study using a point prevalence methodology based on written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted on a randomly selected weeknight during November 2009. Team leaders were asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any. Results Response rate was 82%. Slightly more than half of the team leaders were residents. The median working experience as a surgeon among team leaders was 7.5 years. Sixty-eight percent had participated in multi-professional training in non-technical skills, while 54% had passed the advanced trauma life support(ATLS) course. Fifty-one percent were trained in damage control surgery. A median of one course per team leader was needed to comply with the new proposed national standards. Team leaders considered training in damage control surgery the most needed educational objective. Conclusions Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Proposed national standards should be urgently implemented to ensure equal access to high quality trauma care. PMID:21975088

Young Children: Priority One. A Project Kit for Kiwanis Clubs--Addressing the Needs of Children, Prenatal through Age Five.

ERIC Educational Resources Information Center

Rice, C.; And Others

This Kiwanis Club project kit contains ideas and instructions for implementing programs that meet local needs in the areas of maternal and infant health, child care and development, parenting, and safety and pediatric trauma. The kit begins with an overview that explains how to assess need and how to plan, implement, and evaluate a project. Tip…

Watson Jones Lecture. The organisation of trauma services in the UK.

PubMed Central

Templeton, J.

2000-01-01

To provide a high level of orthopaedic trauma care, education and research, across the country, trauma services in the UK require modification. Good information is necessary prior to formulating ideas and proposals. Trauma care provision must be considered comprehensively at both the national and local levels. As a first step, it is important to know just how many acute hospitals there are in the country. It is also important to know about the distribution of surgical specialities and the number of consultant orthopaedic surgeons staffing those hospitals. Images Figure 1 PMID:10700769

Chronic consequences of acute injuries: worse survival after discharge.

PubMed

Shafi, Shahid; Renfro, Lindsay A; Barnes, Sunni; Rayan, Nadine; Gentilello, Larry M; Fleming, Neil; Ballard, David

2012-09-01

The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score ≥ 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score ≤ 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p > 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictors of long-term mortality given survival to discharge. Log-rank tests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. The survival rate of trauma patients with major injuries remains significantly lower than survival for minor trauma patients and the general population for several months postdischarge. Surveillance for early identification and treatment of complications may be needed for trauma patients with major injuries. Prognostic study, level III.

Key performance indicators in British military trauma.

PubMed

Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

2008-08-01

Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

Peace making/peace keeping missions: role of the U.S. Army nurse.

PubMed

Yoder, Linda H; Brunken, Sandra L

2003-06-01

Somewhere in the world every month expert military critical care/trauma providers are working side-by-side with host nations to help them develop their trauma and disaster management systems. This article discusses the Air Force Medical System's (AFMS) mission to provide humanitarian and civic assistance, disaster response, and care of wartime injured. Within the context of this tripartite mission, the article introduces the AFMS's flagship international course, "Leadership Course in Regional Disaster Response and Trauma System Management," and highlights the that military critical care nurses play in this international effort.

How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007-2012.

PubMed

Dambrauskas, Žilvinas; Aukštakalnis, Vytautas; Karbonskienė, Aurika; Kačiurinas, Dmitrijus; Vokietienė, Jolanta; Lapka, Robertas; Pamerneckas, Algimantas; Porvaneckas, Narūnas; Stašaitis, Kęstutis; Jasinskas, Nedas; Dobožinskas, Paulius; Vaitkaitis, Dinas; Lunevičius, Raimundas

2017-01-01

The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe. Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 "S" and "T" codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers. The Revised Trauma Score (RTS) mean value was 7.45±1.04 for the 2007 year arm; it was 7.53±0.93 for the 2012 year arm (P=0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95min in 2007 vs. 51.6min in 2012 (P=0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision-making was reduced by 16.5% in 2012. Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007-2012 period. Copyright © 2017 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Sp. z o.o. All rights reserved.

Relation between psychotic symptoms, parental care and childhood trauma in severe mental disorders.

PubMed

Catalan, Ana; Angosto, Virxina; Díaz, Aida; Valverde, Cristina; de Artaza, Maider Gonzalez; Sesma, Eva; Maruottolo, Claudio; Galletero, Iñaki; Bustamante, Sonia; Bilbao, Amaia; van Os, Jim; Gonzalez-Torres, Miguel Angel

2017-05-01

A relation between different types of parental care, trauma in childhood and psychotic symptoms in adulthood has been proposed. The nature of this association is not clear and if it is more related to psychotic disorders per se or to a cluster of symptoms such as positive psychotic symptoms remains undefined. We have analysed the presence of childhood trauma using the CTQ scale and types of parental care using the PBI scale in three groups of subjects: borderline personality disorder patients (n=36), first psychotic episode patients (n=61) and healthy controls (n=173). Positive psychotic symptomatology was assessed with the CAPE scale. General linear models were used to study the relation between positive psychotic symptomatology and variables of interest. BPD patients had the highest rate of any kind of trauma, followed by FEP patients. We found a positive relationship between psychotic symptomatology and the existence of trauma in childhood in all groups. Moreover, an affectionless control rearing style was directly associated with the existence of trauma. Furthermore, subjects with trauma presented less probability of having an optimal parenting style in childhood. The relation between psychotic symptoms and trauma remained statistically significant after adjusting for other variables including parental rearing style. There seems to be a link between trauma in childhood and psychotic symptomatology across different populations independently of psychiatric diagnosis. Taking into account that there is an association between trauma and psychosis and that trauma is a modifiable factor, clinicians should pay special attention to these facts. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

[Trauma in the elderly].

PubMed

de Souza, José Antonio Gomes; Iglesias, Antonio Carlos R G

2002-01-01

The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, disproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave differently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and rehabilitation of the elderly victims of trauma.

Debating war-trauma and post-traumatic stress disorder (PTSD) in an interdisciplinary arena.

PubMed

Kienzler, Hanna

2008-07-01

Researchers have tried to determine and verify the effects of violent conflicts on the mental health of those affected by focusing on war trauma, posttraumatic stress disorder (PTSD), and other trauma-related disorders. This, in turn, led to the development of different kinds of theories and aid programs that aim at preventing and treating the consequences of violence and mental health. Until now, there is no agreement on the public health value of the concept of PTSD and no agreement on the appropriate type of mental-health care. Instead, psychiatrists have engaged in sometimes fierce discussions over the universality of war trauma, PTSD, and other trauma-related disorders. The two most polar positions are those who try to validate PTSD as a universal and cross-culturally valid psychopathological response to traumatic distress which may be cured or ameliorated with (Western) clinical and psychosocial therapeutic measures, and those who argue that the Western discourse on trauma only makes sense in the context of a particular cultural and moral framework and, therefore, becomes problematic in the context of other cultural and social settings. Although these positions seem mutually exclusive, their debates have led to the development of less radical approaches toward war-trauma and PTSD. The purpose of this literature review is to analyse the discourses on and debates over war-trauma and PTSD in the psychiatric literature in order to establish a better understanding for the diverse conceptualizations, interpretations and proposed healing strategies. Moreover, I discuss the cultural construction and conceptualization of war-trauma and PTSD from an anthropological perspective and show how anthropologists contribute to psychiatric debates so as to ensure more sophisticated diagnoses and healing strategies in culturally diverse contexts.

Burnout, Perceived Stress, and Job Satisfaction Among Trauma Nurses at a Level I Safety-Net Trauma Center.

PubMed

Munnangi, Swapna; Dupiton, Lynore; Boutin, Anthony; Angus, L D George

Nurses are at the forefront of our health care delivery system and have been reported to exhibit a high level of burnout. Burnout and stress in trauma nurses at a safety-net hospital can negatively impact patient care. Safety-net hospitals are confronted with unique social, financial, as well as resource problems that can potentially make the work environment frustrating. The purpose of this study was to explore the levels of burnout, stress, and job satisfaction in nurses providing care to trauma patients at a Level I safety-net trauma center. A cross-sectional survey design was used to investigate principal factors including personal and professional demographics, burnout, perceived stress, and job satisfaction. Trauma nurses working at a Level I safety-net trauma center are stressed and exhibited moderate degree of burnout. The extent of emotional exhaustion experienced by the nurses varied with work location and was highest in surgical intensive care unit nurses. The level of job satisfaction in terms of opportunities for promotion differed significantly by race and the health status of the nurses. Satisfaction with coworkers was lowest in those nurses between the ages of 60-69 years. Female nurses were more satisfied with their coworkers than male nurses. In addition, the study revealed that significant relationships exist among perceived stress, burnout, and job satisfaction. Work environment significantly impacts burnout, job satisfaction, and perceived stress experienced by trauma nurses in a safety-net hospital. Nursing administration can make an effort to understand the levels of burnout and strategically improve work environment for trauma nurses in order to minimize stressors leading to attrition and enhance job satisfaction.

Mental Trauma Experienced by Caregivers of patients with Diffuse Axonal Injury or Severe Traumatic Brain Injury

PubMed Central

Syed Hassan, Syed Tajuddin; Jamaludin, Husna; Abd Raman, Rosna; Mohd Riji, Haliza; Wan Fei, Khaw

2013-01-01

Context As with care giving and rehabilitation in chronic illnesses, the concern with traumatic brain injury (TBI), particularly with diffuse axonal injury (DAI), is that the caregivers are so overwhelmingly involved in caring and rehabilitation of the victim that in the process they become traumatized themselves. This review intends to shed light on the hidden and silent trauma sustained by the caregivers of severe brain injury survivors. Motor vehicle accident (MVA) is the highest contributor of TBI or DAI. The essence of trauma is the infliction of pain and suffering and having to bear the pain (i.e. by the TBI survivor) and the burden of having to take care and manage and rehabilitate the TBI survivor (i.e. by the TBI caregiver). Moreover many caregivers are not trained for their care giving task, thus compounding the stress of care giving and rehabilitating patients. Most research on TBI including DAI, focus on the survivors and not on the caregivers. TBI injury and its effects and impacts remain the core question of most studies, which are largely based on the quantitative approach. Evidence Acquisition Qualitative research can better assess human sufferings such as in the case of DAI trauma. While quantitative research can measure many psychometric parameters to assess some aspects of trauma conditions, qualitative research is able to fully reveal the meaning, ramification and experience of TBI trauma. Both care giving and rehabilitation are overwhelmingly demanding; hence , they may complicate the caregivers’ stress. However, some positive outcomes also exist. Results Caregivers involved in caring and rehabilitation of TBI victims may become mentally traumatized. Posttraumatic recovery of the TBI survivor can enhance the entire family’s closeness and bonding as well as improve the mental status of the caregiver. Conclusions A long-term longitudinal study encompassing integrated research is needed to fully understand the traumatic experiences of caregivers. Unless research on TBI or DAI trauma is given its proper attention, the burden of trauma and injury on societies will continue to exacerbate globally. PMID:24350153

Perioperative and acute care outcomes in morbidly obese patients with acetabular fractures at a Level 1 trauma center

PubMed Central

Vincent, Heather K.; Haupt, Edward; Tang, Sonya; Egwuatu, Adaeze; Vlasak, Richard; Horodyski, MaryBeth; Carden, Donna; Sadisivan, Kalia K.

2014-01-01

Background Controversy exists regarding obesity-related injury severity and clinical outcomes after orthopedic trauma. Purpose The purposes of this study were to expand our understanding of the effect of morbid obesity on perioperative and acute care outcomes after acetabular fracture. Methods This was a retrospective review of patients with acetabular fracture after trauma. Non-morbidly obese (BMI < 35 kg/m2) and morbidly obese (BMI ≥ 35 kg/m2; N = 81). Injury severity scores and Glasgow Coma Scale scores (GCS) were collected. Perioperative and acute care outcomes were positioning and operative time, extra fractures, estimated blood loss, complications, hospital charges, ventilator days, transfusions, length of stay (LOS) and discharge destination. Positioning and operative times were longer in morbidly obese patients (p < 0.05). No other differences existed between groups. Conclusions Orthopedic trauma surgeons and care teams can expect similar acute care outcomes in morbidly obese and non-morbidly obese patients with acetabular fracture. PMID:25104886

Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes.

PubMed

Chamberlain, Stacey; Stolz, Uwe; Dreifuss, Bradley; Nelson, Sara W; Hammerstedt, Heather; Andinda, Jovita; Maling, Samuel; Bisanzo, Mark

2015-01-01

Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.

Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

PubMed

West, Sarah Katherine

2016-01-01

This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.

General surgical services at an urban teaching hospital in Mozambique.

PubMed

Snyder, Elizabeth; Amado, Vanda; Jacobe, Mário; Sacks, Greg D; Bruzoni, Matias; Mapasse, Domingos; DeUgarte, Daniel A

2015-10-01

As surgery becomes incorporated into global health programs, it will be critical for clinicians to take into account already existing surgical care systems within low-income countries. To inform future efforts to expand the local system and systems in comparable regions of the developing world, we aimed to describe current patterns of surgical care at a major urban teaching hospital in Mozambique. We performed a retrospective review of all general surgery patients treated between August 2012 and August 2013 at the Hospital Central Maputo in Maputo, Mozambique. We reviewed emergency and elective surgical logbooks, inpatient discharge records, and death records to report case volume, disease etiology, and mortality. There were 1598 operations (910 emergency and 688 elective) and 2606 patient discharges during our study period. The most common emergent surgeries were for nontrauma laparotomy (22%) followed by all trauma procedures (18%), whereas the most common elective surgery was hernia repair (31%). The majority of lower extremity amputations were above knee (69%). The most common diagnostic categories for inpatients were infectious (31%), trauma (18%), hernia (12%), neoplasm (10%), and appendicitis (5%). The mortality rate was 5.6% (146 deaths), approximately half of which were related to sepsis. Our data demonstrate the general surgery caseload of a large, academic, urban training and referral center in Mozambique. We describe resource limitations that impact operative capacity, trauma care, and management of amputations and cancer. These findings highlight challenges that are applicable to a broad range of global surgery efforts. Copyright © 2015 Elsevier Inc. All rights reserved.

Team play in surgical education: a simulation-based study.

PubMed

Marr, Mollie; Hemmert, Keith; Nguyen, Andrew H; Combs, Ronnie; Annamalai, Alagappan; Miller, George; Pachter, H Leon; Turner, James; Rifkind, Kenneth; Cohen, Steven M

2012-01-01

Simulation-based training provides a low-stress learning environment where real-life emergencies can be practiced. Simulation can improve surgical education and patient care in crisis situations through a team approach emphasizing interpersonal and communication skills. This study assessed the effects of simulation-based training in the context of trauma resuscitation in teams of trainees. In a New York State-certified level I trauma center, trauma alerts were assessed by a standardized video review process. Simulation training was provided in various trauma situations followed by a debriefing period. The outcomes measured included the number of healthcare workers involved in the resuscitation, the percentage of healthcare workers in role position, time to intubation, time to intubation from paralysis, time to obtain first imaging study, time to leave trauma bay for computed tomography scan or the operating room, presence of team leader, and presence of spinal stabilization. Thirty cases were video analyzed presimulation and postsimulation training. The two data sets were compared via a 1-sided t test for significance (p < 0.05). Nominal data were analyzed using the Fischer exact test. The data were compared presimulation and postsimulation. The number of healthcare workers involved in the resuscitation decreased from 8.5 to 5.7 postsimulation (p < 0.001). The percentage of people in role positions increased from 57.8% to 83.6% (p = 0.46). The time to intubation from paralysis decreased from 3.9 to 2.8 minutes (p < 0.05). The presence of a definitive team leader increased from 64% to 90% (p < 0.05). The rate of spine stabilization increased from 82% to 100% (p < 0.08). After simulation, training adherence to the advanced trauma life support algorithm improved from 56% to 83%. High-stress situations simulated in a low-stress environment can improve team interaction and educational competencies. Providing simulation training as a tool for surgical education may enhance patient care. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Management of pediatric multiple trauma patients. Perspective of the pediatric intensive care unit].

PubMed

Carreras González, E; Rey Galán, C; Concha Torre, A; Cañadas Palaz, S; Serrano González, A; Cambra Lasaosa, F J

2007-08-01

To study the epidemiology and management of pediatric trauma patients as well as the organizational, human and technical resources dedicated to these children from the perspective of the pediatric intensive care unit (PICU). A standardized data collection form was sent to 43 PICUs in Spain. Items inquired about the existence of training courses, trauma clinical practice guidelines and trauma registers, and which physician was in charge of trauma patients. Data on casuistics, the age of trauma patients, and the availability of human and technical resources, were also recorded. Twenty-four PICUs completed the questionnaire. The PICU physician was responsible for trauma patient care in 66% of the hospitals. No training courses were available in 59% of the hospitals. No trauma register was available in 62% of the hospitals. Trauma patients represented 11% of PICU admissions, and most patients were aged up to 14 years old. An anesthetist was always at the hospital in 100% of the hospitals. A radiologist and traumatologist were always at the hospital in 91%, a neurosurgeon in 66% and a pediatric surgeon in 50%. The remaining surgical and medical specialties were on call. Continuous intracranial pressure monitoring was available in 87% of the PICUs, jugular venous saturation monitoring in 54% and continuous electroencephalogram and transcranial Doppler ultrasound in 50%. Computed tomography and ultrasound were available at all times in all hospitals. Magnetic nuclear resonance and echocardiography were available at all times in 44% of the hospitals, and arteriography in 42%. In Spain, the organization of pediatric trauma management is based on pediatric teams under the supervision of a PICU physician. Some hospitals show a lack of technical and human resources. Therefore, the minimum criteria required to consider a hospital as a pediatric trauma center should be established. Trauma training courses are required.

Exploring the characteristics of high-performing hospitals that influence trauma triage and transfer.

PubMed

Gagliardi, Anna R; Nathens, Avery B

2015-02-01

Many trauma patients might be first cared for at nondesignated centers before transfer to a trauma center. Limited research has investigated determinants of timely triage and transfer to identify those amenable to quality improvement. This study explored factors influencing timely triage and transfer in a regional trauma system. Centers (n = 15) with both long and short transfer times (emergency department length of stay before transfer) in Ontario were identified using a regional trauma registry. Physicians and nurses in these centers were interviewed with a view to determining factors that either impeded or enabled rapid decisions regarding the need for transfer to a trauma center. A grounded theory approach and constant comparative technique were used to collect and analyze data. Nineteen physicians and eight nurses participated. Clinician level (experience, training, personality, fear of judgment, nursing role), institutional level (guidelines, continuing education, trauma infrastructure, human resources) and system-level (bed availability, referral center, air transport, communication with trauma centers) factors influenced timely decision making. Participants offered several recommendations to improve care. These included guidelines for transfer, a "no refusal" policy at trauma centers, improved air transport and referral center services, as well as further regionalization. Additional features of hospitals with shorter transfer times included coaching of new staff, team meetings, leadership engagement, sharing of performance data, and minimum work hours for physicians. Numerous interacting factors that may influence trauma triage and transfer were identified. These findings can be used by policy makers, health care managers, and clinicians in emergency departments or trauma centers to evaluate and improve trauma triage and transfer, or plan new services. The findings can also be used by researchers to examine the relevance of these factors in other settings or to implement and evaluate the impact of interventions informed by recommendations generated here.

Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems.

PubMed

Suarez, Liza M; Belcher, Harolyn M E; Briggs, Ernestine C; Titus, Janet C

2012-06-01

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.

The impact of patient protection and Affordable Care Act on trauma care: A step in the right direction.

PubMed

Joseph, Bellal; Haider, Ansab A; Azim, Asad; Kulvatunyou, Narong; Tang, Andrew; OʼKeeffe, Terence; Latifi, Rifat; Green, Donald J; Friese, Randall S; Rhee, Peter

2016-09-01

The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements, and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our Level I trauma center following the ACA, and this is associated with improved reimbursement. We performed a retrospective analysis of the trauma registry and financial database at our Level I trauma center for a 27-month (July 2012 to September 2014) period by quarters. Our outcome measures were change in insurance status, hospital reimbursement rates (total payments/expected payments), and clinical outcomes before and after ACA (March 31, 2014). Trend analysis was performed to assess trends in outcomes over each quarter (3 months). A total of 9,892 patients were included in the study. The overall uninsured rate during the study period was 20.3%. Post-ACA period was associated with significantly lower uninsured rate (p < 0.001). During the same time, there was as a significant increase in the Medicaid patients (p = 0.009). This was associated with significantly improved hospital reimbursements (p < 0.001).On assessing clinical outcomes, there was no change in hospitalization (p = 0.07), operating room procedures (p = 0.99), mortality (p = 0.88), or complications (p = 0.20). Post-ACA period was also not associated with any change in the hospital (p = 0.28) or length of stay at intensive care unit (p = 0.66). The implementation of ACA has led to a decrease in the number of uninsured trauma patients. There was a significant increase in Medicaid trauma patients. This was associated with an increase in hospital reimbursements that substantially improved the financial revenues. Despite the controversies, implementation of ACA has the potential to substantially improve the financial outcomes of trauma centers through Medicaid expansion. Economic and value-based evaluation, level III.

Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study.

PubMed

Mohr, Nicholas M; Harland, Karisa K; Chrischilles, Elizabeth A; Bell, Amanda; Shane, Dan M; Ward, Marcia M

2017-02-01

Traumatic injury is a leading cause of death in the United States, and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient-level factors associated with telemedicine consultation in North Dakota critical-access hospital (CAH) emergency departments (EDs) and to measure the association between telemedicine consultation and interhospital transfer. Observational cohort study of all adult (age ≥ 18 years) trauma patients treated in North Dakota CAH EDs with an active telemedicine subscription between 2008 and 2014. Trauma cases were identified from the North Dakota Trauma Registry, and telemedicine-enabled care was determined using a probabilistic linking algorithm with the call records of the predominant telemedicine network in North Dakota. Multivariable generalized estimating equations were used to identify factors associated with telemedicine consultation and to measure the association between telemedicine consultation and interhospital transfer, adjusting for patient, injury, and hospital factors. Of the 9,281 North Dakota trauma patients seen in CAHs, 2,837 were treated in an ED with an active telemedicine subscription. Telemedicine was consulted for 11% of all trauma patients in telemedicine-capable EDs. Factors associated with telemedicine consultation included higher Injury Severity Score, penetrating injuries, burns, hypotension, tachycardia, and ambulance transport. Adjusting for severity of illness, injury mechanism, and type of injury, telemedicine use was not associated with interhospital transfer (adjusted odds ratio = 1.28, 95% confidence interval = 0.94 to 1.75). Emergency department-based telemedicine consultation is requested for the most severely injured rural trauma patients, especially with those with penetrating trauma, burns, and abnormal presenting vital signs. Telemedicine consultation was not independently associated with increased probability of transfer. Future work should evaluate how telemedicine impacts the timeliness of care and specific care interventions. © 2016 by the Society for Academic Emergency Medicine.

Including fall prevention for older adults in your trauma injury prevention program--introducing Farewell to Falls.

PubMed

Corman, Ellen

2009-01-01

With data showing that more than 50% of visits to our trauma center for older adults 65 years and older are due to falls, injury prevention programs in trauma centers should be paying more attention to the area of fall prevention for older adults. Farewell to Falls, a free, home-based program of Stanford Hospital and Clinic's trauma service, utilizes a multifaceted approach to help reduce falls. In addition to improving the lives of seniors, the program fulfills a community benefit goal and provides strong hospital marketing opportunities. This program is a benefit to hospitals and the older adults they serve.

Accessing new understandings of trauma-informed care with queer birthing women in a rural context.

PubMed

Searle, Jennifer; Goldberg, Lisa; Aston, Megan; Burrow, Sylvia

2017-11-01

Participant narratives from a feminist and queer phenomenological study aim to broaden current understandings of trauma. Examining structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. Analysis of the qualitative data was guided by feminist and queer phenomenology. This was well suited to understanding queer women's storied narratives of trauma, including disempowering processes of structural marginalisation. Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that reconstructs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. New trauma-informed assessment strategies reconstruct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re-experiencing the process of coming out as queer in opposition to the expectation of heterosexuality. © 2017 John Wiley & Sons Ltd.

Minimizing preventable trauma deaths in a limited-resource setting: a test-case of a multidisciplinary panel review approach at the Komfo Anokye Teaching Hospital in Ghana.

PubMed

Yeboah, Dominic; Mock, Charles; Karikari, Patrick; Agyei-Baffour, Peter; Donkor, Peter; Ebel, Beth

2014-07-01

Our objectives were to determine the proportion of preventable trauma deaths at a large trauma hospital in Kumasi, Ghana, and to identify opportunities for the improvement of trauma care. A multidisciplinary panel of experts evaluated pre-hospital, hospital, and postmortem data of consecutive trauma patients who died over a 5-month period in 2006-2007 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For preventable and potentially preventable deaths, deficiencies in care that contributed to their deaths were identified. The panel reviewed 231 trauma deaths. Of these, 84 charts had sufficient information to review preventable factors. The panel determined that 23 % of trauma deaths were definitely preventable, 37 % were potentially preventable, and 40 % were not preventable. One main deficiency in care was identified for each of the 50 definitely preventable and potentially preventable deaths. The most common deficiencies were pre-hospital delays (44 % of the 50 deficiencies), delay in treatment (32 %), and inadequate fluid resuscitation (22 %). Among the 19 definitely preventable deaths, the most common cause of death was hemorrhage (47 %), and the most common deficiencies were inadequate fluid resuscitation (37 % of deficiencies in this group) and pre-hospital delay (37 %). A high proportion of trauma fatalities might have been preventable by decreasing pre-hospital delays, adequate resuscitation in hospital, and earlier initiation of care, including definitive surgical management. The study also showed that preventable death panel reviews are a feasible and useful quality improvement method in the study setting.

Statewide real-time in-flight trauma patient vital signs collection system.

PubMed

Hu, Peter F; Mackenzie, Colin; Dutton, Richard; Sen, Ayan; Xiao, Yan; Handley, Christopher; Ho, Danny; Scalea, Thomas

2008-11-06

Continuous recorded in-flight vital signs monitoring and life-saving interventions linked to outcomes may provide better understanding of pre-hospital triage, care management and patient responses during the 'golden hour' of trauma care. Evaluation of 157 patients' vital signs data collected from our statewide network has identified episodes of physiological decompensation which holds promise for creation of new triage algorithms and enhanced trauma center preparedness.

Chronic Childhood Trauma, Mental Health, Academic Achievement, and School-Based Health Center Mental Health Services.

PubMed

Larson, Satu; Chapman, Susan; Spetz, Joanne; Brindis, Claire D

2017-09-01

Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities. Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if research was related to childhood trauma's effects, mental health care disparities, SBHC mental health services, or SBHC impact on academic achievement. Eight studies show a significant risk of mental health disorders and poor academic achievement when exposed to childhood trauma. Seven studies found significant disparities in pediatric mental health care in the US. Nine studies reviewed SBHC mental health service access, utilization, quality, funding, and impact on school achievement. Exposure to chronic childhood trauma negatively impacts school achievement when mediated by mental health disorders. Disparities are common in pediatric mental health care in the United States. SBHC mental health services have some showed evidence of their ability to reduce, though not eradicate, mental health care disparities. © 2017, American School Health Association.

The experiences of orthopaedic and trauma nurses who have cared for adults with a learning disability.

PubMed

Drozd, Mary; Clinch, Christine

2016-08-01

There is no published empirical research about the experiences of orthopaedic and trauma nurses who have cared for people with a learning disability. However, adults with a learning disability sustain more injuries, falls and accidents than the general population. Because of their increased health needs, there has been a corresponding increase in their numbers attending general/acute hospitals. The 6 Cs is a contemporary framework and has been used to gauge how orthopaedic and trauma nurses rate the Care, Communication, Competence, Commitment, Courage and Compassion for patients with a learning disability in orthopaedic and trauma hospital settings compared to patients without a learning disability. The aim of the study was to explore the experiences of orthopaedic and trauma nurses who have cared for people with a learning disability. The study is based on a descriptive survey design and used a questionnaire to elicit data from participants. A convenience sample of Registered Nurses completed a questionnaire. The study was explained to delegates attending a concurrent session on the topic of acute hospital care for people with a learning disability at a conference and the questionnaire was left on a table for participants to take if they wished. Questionnaires were returned anonymously. Of the participants who had completed the questionnaire 100% (n = 13) had cared for a patient with a learning disability. Using the 6 Cs as a framework suggested that care, communication and competence of nurses were worse for people with a learning disability than for people without a learning disability. Three main themes emerged regarding areas of good practices: (1) promoting a positive partnership with patients and carers; (2) modifying care and interventions; (3) supporting the healthcare team. There was evidence of good practices within orthopaedic and trauma settings such as the active involvement of family or a paid carer who is known to thepatient and the modification of care and interventions along with specialist advice and support from the Acute Liaison Learning Disability Nurse. There were areas of concern such as the lack of use of Hospital Passports and the inconsistent implementation of reasonable and achievable adjustments. It is unknown if the care for patients with a learning disability is adequate. However, the themes that have emerged accord with the key domains in 'A competency framework for orthopaedic and trauma practitioners' (Royal College of Nursing 2012a, 2012b) and therefore could be considered for inclusion in future orthopaedic and trauma competencies to enable sharing of best practices. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors influencing the incidence of maxillofacial fractures.

PubMed

Chrcanovic, Bruno Ramos

2012-03-01

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed. An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures. From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma. Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.

A population based study on the night-time effect in trauma care.

PubMed

Di Bartolomeo, Stefano; Marino, Massimiliano; Ventura, Chiara; Trombetti, Susanna; De Palma, Rossana

2014-10-01

The so-called off hour effect-that is, increased mortality for patients admitted outside normal working hours-has never been demonstrated in trauma care. However, most of the studies excluded transferred cases. Because these patients are a special challenge for trauma systems, we hypothesised that their processes of care could be more sensitive to the off hour effect. The study design was retrospective, cohort and population based. We compared the mortality of all patients by daytime and night-time admittance to hospitals in an Italian region, with 4.5 million inhabitants, following a major injury in 2011. Logistic regression was used, adjusted for demographics and severity of injury (TMPM-ICD9), and stratified by transfer status. 1940 major trauma cases were included; 105 were acutely transferred. Night-time admission had a significant pejorative effect on mortality in the adjusted analysis (OR=1.49; 95% CI 1.05 to 2.11). This effect was most evident in transferred cases (OR=3.71; 95% CI 1.11 to 12.43). The night-time effect in trauma care was demonstrated for the first time and was maximal in transferred cases. This may explain why it was not found in previous studies where these patients were mostly excluded. Also, the use of population based data-whereby patients not accessing trauma centre care and presumably receiving poorer care were included-may have contributed to the findings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Strategic Assessment of Trauma Care Capacity in Ghana.

PubMed

Stewart, Barclay T; Quansah, Robert; Gyedu, Adam; Ankomah, James; Donkor, Peter; Mock, Charles

2015-10-01

This study aimed to assess availability of trauma care technology in Ghana. In addition, factors contributing to deficiencies were evaluated. By doing so, potential solutions to inefficient aspects of health systems management and maladapted technology for trauma care in low- and middle-income countries (LMICs) could be identified. Thirty-two items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical, and biomedical engineering staff were used to assess the challenges and successes of item availability at 40 purposively sampled district, regional, and tertiary hospitals. Hospital assessments demonstrated marked deficiencies. Some of these were low cost, such as basic airway supplies, chest tubes, and cervical collars. Item non-availability resulted from several contributing factors, namely equipment absence, lack of training, frequent stock-outs, and technology breakage. A number of root causes for these factors were identified, including ineffective healthcare financing by way of untimely national insurance reimbursements, procurement and stock-management practices, and critical gaps in local biomedical engineering and trauma care training. Nonetheless, local examples of successfully overcoming deficiencies were identified (e.g., public-private partnering, ensuring company engineers trained technicians on-the-job during technology installation or servicing). While availability of several low-cost items could be better supplied by improvements in stock-management and procurement policies, there is a critical need for redress of the national insurance reimbursement system and trauma care training of district hospital staff. Further, developing local service and technical support capabilities is more and more pressing as technology plays an increasingly important role in LMIC healthcare systems.

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?

PubMed

Clarke, D L; Aldous, C; Thomson, S R

2014-06-01

This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and deliver all acute trauma patients to large regional trauma centers. If the first option is chosen, urgent intervention is required to build up the human resource capacity of district hospitals.

Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services.

PubMed

Wandling, Michael W; Nathens, Avery B; Shapiro, Michael B; Haut, Elliott R

2018-02-01

Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes. To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems. Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle. In-hospital mortality. Of the 2 329 446 records assessed for eligibility, 103 029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR,  0.45; 95% CI, 0.36-0.56) and stab wound (OR,  0.32; 95% CI, 0.20-0.52) subgroups. Private vehicle transport is associated with a significantly lower likelihood of death when compared with ground EMS transport for individuals with gunshot wounds and stab wounds in urban US trauma systems. System-level evidence such as this can be a valuable tool for those responsible for developing and implementing policies at the trauma system level.

Inclusion of 'minor' trauma cases provides a better estimate of the total burden of injury: Queensland Trauma Registry provides a unique perspective.

PubMed

Lang, Jacelle; Dallow, Natalie; Lang, Austin; Tetsworth, Kevin; Harvey, Kathy; Pollard, Cliff; Bellamy, Nicholas

2014-08-01

Injury is recognised as a frequent cause of preventable mortality and morbidity; however, incidence estimates focusing only on the extent of mortality and major trauma may seriously underestimate the magnitude of the total injury burden. There currently exists a paucity of information regarding minor trauma, and the aim of this study was to increase awareness of the contribution of minor trauma cases to the total burden of injury. The demographics, injury details, acute care factors and outcomes of both minor trauma cases and major trauma cases were evaluated using data from the state-wide trauma registry in Queensland, Australia, from 2005 to 2010. The impact of changes in Abbreviated Injury Scale (AIS) versions on the classification of minor and major injury cases was also assessed. Over the 6-year period, minor cases [Injury Severity Score (ISS) ≤ 12] accounted for almost 90% of all trauma included on the Queensland Trauma Registry (QTR). These cases utilised more than half a million acute care bed days, underwent more than 66,500 operations, and accounted for more than 48,000 patient transport episodes via road ambulance, fixed wing aircraft, or helicopter. Furthermore, more than 5800 minor trauma cases utilised in-hospital rehabilitation services; almost 3000 were admitted to an ICU; and more than 20,000 were admitted to hospital for greater than one week. When using the contemporary criteria for classifying trauma (AIS 08), the proportion of cases classified as minor trauma (87.7%) and major trauma (12.3%) were similar to the proportion using the traditional criteria for AIS90 (87.9% and 12.1%, respectively). This evaluation of minor trauma cases admitted to public hospitals in Queensland detected high levels of demand placed on trauma system resources in terms of acute care bed days, operations, ICU admissions, in-hospital rehabilitation services and patient transportation, and which are all associated with high cost. These data convincingly demonstrate the significant burden of injury imposed by minor trauma cases serious enough to be admitted to hospital. Copyright © 2014 Elsevier Ltd. All rights reserved.

Epidemiology and outcome of penetrating injuries in a Western European urban region.

PubMed

Störmann, P; Gartner, K; Wyen, H; Lustenberger, T; Marzi, I; Wutzler, S

2016-12-01

Severe life-threatening injuries in Western Europe are mostly caused by blunt trauma. However, penetrating trauma might be more common in urban regions, but their characteristics have not been fully elucidated. Retrospective analysis of data from patients admitted to our urban university level I trauma center between 2008 and 2013 with suspicion of severe multiple injuries. Collection of data was performed prospectively using a PC-supported online documentation program including epidemiological, clinical and outcome parameters. Out of 2095 trauma room patients admitted over the 6-year time period 194 (9.3 %) suffered from penetrating trauma. The mean Injury Severity Score (ISS) was 12.3 ± 14.1 points. In 62.4 % (n = 121) the penetrating injuries were caused by interpersonal violence or attempted suicide, 98 of these by stabbing and 23 by firearms. We observed a widespread injury pattern where mainly head, thorax and abdomen were afflicted. Subgroup analysis for self-inflicted injuries showed higher ISS (19.8 ± 21.8 points) than for blunt trauma (15.5 ± 14.6 points). In 82.5 % of all penetrating trauma a surgical treatment was performed, 43.8 % of the patients received intensive care unit treatment with mean duration of 7.4 ± 9.3 days. Immediate emergency surgical treatment had to be performed in 8.0 vs. 2.3 % in blunt trauma (p < 0.001). Infectious complications of the penetrating wounds were observed in 7.8 %. Specific characteristics of penetrating trauma in urban regions can be identified. Compared to nationwide data, penetrating trauma was more frequent in our collective (9.3 vs. 5.0 %), which may be due to higher crime rates in urban areas. Especially, self-inflicted penetrating trauma often results in most severe injuries.

Variability in interhospital trauma data coding and scoring: A challenge to the accuracy of aggregated trauma registries.

PubMed

Arabian, Sandra S; Marcus, Michael; Captain, Kevin; Pomphrey, Michelle; Breeze, Janis; Wolfe, Jennefer; Bugaev, Nikolay; Rabinovici, Reuven

2015-09-01

Analyses of data aggregated in state and national trauma registries provide the platform for clinical, research, development, and quality improvement efforts in trauma systems. However, the interhospital variability and accuracy in data abstraction and coding have not yet been directly evaluated. This multi-institutional, Web-based, anonymous study examines interhospital variability and accuracy in data coding and scoring by registrars. Eighty-two American College of Surgeons (ACS)/state-verified Level I and II trauma centers were invited to determine different data elements including diagnostic, procedure, and Abbreviated Injury Scale (AIS) coding as well as selected National Trauma Data Bank definitions for the same fictitious case. Variability and accuracy in data entries were assessed by the maximal percent agreement among the registrars for the tested data elements, and 95% confidence intervals were computed to compare this level of agreement to the ideal value of 100%. Variability and accuracy in all elements were compared (χ testing) based on Trauma Quality Improvement Program (TQIP) membership, level of trauma center, ACS verification, and registrar's certifications. Fifty registrars (61%) completed the survey. The overall accuracy for all tested elements was 64%. Variability was noted in all examined parameters except for the place of occurrence code in all groups and the lower extremity AIS code in Level II trauma centers and in the Certified Specialist in Trauma Registry- and Certified Abbreviated Injury Scale Specialist-certified registrar groups. No differences in variability were noted when groups were compared based on TQIP membership, level of center, ACS verification, and registrar's certifications, except for prehospital Glasgow Coma Scale (GCS), where TQIP respondents agreed more than non-TQIP centers (p = 0.004). There is variability and inaccuracy in interhospital data coding and scoring of injury information. This finding casts doubt on the validity of registry data used in all aspects of trauma care and injury surveillance.

Trauma system evaluation in developing countries: applicability of American College of Surgeons/Committee on Trauma (ACS/COT) basic criteria.

PubMed

Latifi, Rifat; Ziemba, Michelle; Leppäniemi, Ari; Dasho, Erion; Dogjani, Agron; Shatri, Zhaneta; Kociraj, Agim; Oldashi, Fatos; Shosha, Lida

2014-08-01

Trauma continues to be a major health problem worldwide, particularly in the developing world, with high mortality and morbidity. Yet most developing countries lack an organized trauma system. Furthermore, developing countries do not have in place any accreditation process for trauma centers; thus, no accepted standard assessment tools exist to evaluate their trauma services. The aims of this study were to evaluate the trauma system in Albania, using the basic trauma criteria of the American College of Surgeons/Committee on Trauma (ACS/COT) as assessment tools, and to provide the Government with a situational analysis relative to these criteria. We used the ACS/COT basic criteria as assessment tools to evaluate the trauma system in Albania. We conducted a series of semi-structured interviews, unstructured interviews, and focus groups with all stakeholders at the Ministry of Health, at the University Trauma Hospital (UTH) based in Tirana (the capital city), and at ten regional hospitals across the country. Albania has a dedicated national trauma center that serves as the only tertiary center, plus ten regional hospitals that provide some trauma care. However, overall, its trauma system is in need of major reforms involving all essential elements in order to meet the basic requirements of a structured trauma system. The ACS/COT basic criteria can be used as assessment tools to evaluate trauma care in developing countries. Further studies are needed in other developing countries to validate the applicability of these criteria.

The cumulative effect of multiple critical care protocols on length of stay in a geriatric trauma population.

PubMed

Frederickson, Tiffany A; Renner, Catherine Hackett; Swegle, James R; Sahr, Sheryl M

2013-01-01

The elderly individuals are the most rapidly growing cohort within the US population, and a corresponding increase is being seen in elderly trauma patients. Elderly patients are more likely to have a hospital length of stay (LOS) in excess of 10 days. They account for 60% of total ICU days. Length of stay is frequently used as a proxy measure for improvement in injury outcomes, changes in quality of care, and hospital outcomes. Patient care protocols are typically created from evidence-based guidelines that serve to reduce variation in care from patient to patient. Patient care protocols have been found to positively impact patient care with reduced duration of mechanical ventilation, shorter LOS in the ICU and shorter overall hospitalization time, reduced mortality, and reduced health care costs. The following study was designed to assess the impact of the implementation of 4 patient care protocols within an elderly trauma population. We hypothesized that the implementation of these protocols would have a beneficial impact on patient care that could be measured by a decrease in hospital LOS. An archival, retrospective pretest/posttest study was performed on elderly trauma patients. The new protocols helped guide practical changes in care that resulted in a 32% decrease in LOS for our elderly trauma patients which exceeds the 25% decrease found in other studies. Additionally, the "Other" category for each variable was less frequently used in the post-protocol phase than in the pre-protocol phase, suggesting a spillover effect on the level of detail recorded in the patient chart. With less variation in practices in the post-protocol phase, Injury Severity score, and admission systolic blood pressure emerged as significant predictors of LOS.

Characteristics of Emergency Medicine Residency Programs in Colombia

PubMed Central

Patiño, Andrés; Alcalde, Victor; Gutierrez, Camilo; Romero, Mauricio Garcia; Carrillo, Atilio Moreno; Vargas, Luis E.; Vallejo, Carlos E.; Zarama, Virginia; Mora Rodriguez, José L.; Bustos, Yury; Granada, Juliana; Aguiar, Leonar G.; Menéndez, Salvador; Cohen, Jorge I.; Saavedra, Miguel A.; Rodriguez, Juan M.; Roldan, Tatiana; Arbelaez, Christian

2017-01-01

Introduction Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. Methods We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013–2016. Topics included program characteristics and curricula. Results Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3–10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2–15. EM rotation requirements range from 11–33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1–2 months of pediatrics or pediatric EM. Critical care requirements range from 4–7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4–6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. Conclusion As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs. PMID:29085546

Characteristics of Emergency Medicine Residency Programs in Colombia.

PubMed

Patiño, Andrés; Alcalde, Victor; Gutierrez, Camilo; Romero, Mauricio Garcia; Carrillo, Atilio Moreno; Vargas, Luis E; Vallejo, Carlos E; Zarama, Virginia; Mora Rodriguez, José L; Bustos, Yury; Granada, Juliana; Aguiar, Leonar G; Menéndez, Salvador; Cohen, Jorge I; Saavedra, Miguel A; Rodriguez, Juan M; Roldan, Tatiana; Arbelaez, Christian

2017-10-01

Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs.

Morbidity and injury recurrence in victims of firearm injuries.

PubMed

Ponzer, S; Bergman, B; Brismar, B

1996-01-01

Civilian violence has become an increasing problem in the industrial world. Gunshot wounds, fatal or non-fatal, are often considered as acute trauma episodes. However, our previous study, based on 820 firearm injuries, showed that this group of patients was characterized by a high mortality rate and a pronounced involvement in criminality when compared to a control group. The aim of this study was to determine the general morbidity in the same group of firearm victims. Our hypotheses were that these patients consume a considerable amount of hospital care due to recurring trauma episodes and that their general morbidity is raised. Information was collected concerning all episodes of in-patient care for victims of firearm injuries from 1972-1992 in Stockholm, Sweden. The victims were compared with a sex- and age-matched control group. During the study period, 69.9% of the 820 firearm victims were treated for other reasons than gunshot injuries, compared to 45.5% of the 820 controls. The former group was hospitalized 3,703 times and the latter on 1,512 occasions. The firearm injury group showed an higher morbidity in almost all diagnostic subgroups according to ICD-9. The trauma recurrence rate was high and suicide, homicide and assault were relatively more common in this group. We suggest that the gunshot episode may be regarded as one expression of a "chronic trauma syndrome'. Patients exhibiting this "syndrome' are characterized by recurrent episodes of trauma, a risk-taking and destructive behavior, high morbidity and mortality as well as anti-social traits. Medical, social and legal complications are common making these patients extremely costly for society and their identification a matter of concern. It is probable that this "syndrome' also exists in other groups of trauma patients. Since hospitalization affords a unique opportunity of reaching patients who have a "chronic trauma syndrome' risk profile, we believe, that these patients should not only be treated for their acute injuries, but that they should be offered help in order to change their destructive life-style. Research should be undertaken to evaluate whether an intervention program, such as counseling, could have an effect on morbidity and injury recurrence for these patients.

Quality of trauma care and trauma registries.

PubMed

Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

2015-03-01

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Trauma and fear in Australian midwives.

PubMed

Toohill, J; Fenwick, J; Sidebotham, M; Gamble, J; Creedy, D K

2018-05-11

Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice. (1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives' confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives' experiences of birth related trauma and/or fear. A mixed methods design. A convenience sample of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma. The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having 'high fear' reported more practice concerns (Med 23.5, n=20) than midwives with 'low fear' (Med 8, n=212) (U=1396, z=-3.79, p<0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma. High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

77 FR 33201 - Federal Advisory Committee; Defense Health Board (DHB) Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

..., Development, Test and Evaluation Priorities for Battlefield Trauma Care from the Trauma and Injury Subcommittee. Additionally, the Board will receive information briefs from the National Trauma Institute and U...

Challenges in the Management of Geriatric Trauma: A Case Report.

PubMed

Gaebel, Ashley; Keiser, Megan

This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.

Quality in trauma care: improving the discharge procedure of patients by means of Lean Six Sigma.

PubMed

Niemeijer, Gerard C; Trip, Albert; Ahaus, Kees T B; Does, Ronald J M M; Wendt, Klaus W

2010-09-01

The University Medical Center Groningen is a level I trauma center in the northern part of the Netherlands. Sixty-three percent of all the patients admitted at the Trauma Nursing Department (TND) are acute patients who are admitted directly after trauma. In 2006 and 2007, the University Medical Center Groningen was not always capable of admitting all trauma patients to the TND due to the relatively high-bed occupation. Therefore, the reduction of the average length of stay (LOS) formed the objective of the project described in this study. We used the process-focused method of Lean Six Sigma to reduce hospital stay by improving the discharge procedure of patients in the care processes and eliminating waste and waiting time. We used the "Dutch Appropriateness Evaluation Protocol" to identify the possible causes of inappropriate hospital stay. The average LOS of trauma patients at the TND at the beginning of the project was 10.4 days. Thirty percent of the LOS was unnecessary. The main causes of the inappropriate hospital stay were delays in several areas. The implementation of the improvement plan reduced almost 50% of the inappropriate hospital stay, enabling the trauma center to admit almost all trauma patients to the TND. After the implementation of the improvements, the average LOS was 8.5 days. Our study shows that Lean Six Sigma is an effective method to reduce inappropriate hospital stay, thereby improving the quality and financial efficiency of trauma care.

Perceptions of an educational programme for registered nurses who work at non-major trauma services in Victoria, Australia: The Nursing Emergency eXternal Trauma Programme.

PubMed

Ireland, Sharyn; Cross, Rachel; Decker, Kelly; Mitra, Biswadev

2017-08-01

Emergency nurses working in non-Major Trauma Service (non-MTS) facilities face the challenge of providing immediate care to seriously injured patients, despite infrequent presentations at their workplace. A one-day education programme endorsed by the Australian College of Nursing was developed to provide contemporary trauma education for nurses. The aim of this study was to report participants' perceptions of their experience of this programme. Peer reviewed lesson plans were developed to guide educational activities. Of 32 participants, 24 consented to and completed pre and post-programme surveys. Thematic analysis and descriptive statistics were used to report study findings. Most participants were nurses with greater than two years' experience in Emergency Nursing (92%). Trauma patient transfers each year from a non-MTS to a Major Trauma Service occurred infrequently; eight nurses (33.3%) reported greater than10 trauma transfers per year. Participant expectations of the programme included personal growth, knowledge acquisition, increased confidence and a focus on technical skills. Participants reported the day to be worthwhile and valuable; improved confidence, increased knowledge, and the opportunity to discuss current evidence based practice were highly regarded. Recommendations for future programmes included extending to two days and include burns and more complex pathophysiology. With centralisation of trauma care to major trauma services, frequent and continuing education of nurses is essential. Nurses from non-Major Trauma Service facilities in Victoria found this programme worthwhile as they gained knowledge and skills and increased confidence to care for trauma patients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana.

PubMed

Ankomah, James; Stewart, Barclay T; Oppong-Nketia, Victor; Koranteng, Adofo; Gyedu, Adam; Quansah, Robert; Donkor, Peter; Abantanga, Francis; Mock, Charles

2015-11-01

This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Ten universal and 9 pediatric-sized items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable X-ray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage. Copyright © 2015 Elsevier Inc. All rights reserved.

Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana

PubMed Central

Ankomah, James; Stewart, Barclay T; Oppong-Nketia, Victor; Koranteng, Adofo; Gyedu, Adam; Quansah, Robert; Donkor, Peter; Abantanga, Francis; Mock, Charles

2015-01-01

Background This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Methods Ten universal and 9 pediatric-sized items were selected from the World Health Organization’s Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Results Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable Xray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. Conclusion This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage. PMID:25841284

Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

PubMed

Geiling, James; Rosen, Joseph M; Edwards, Ryan D

2012-11-01

War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

77 FR 61615 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-10

... addressing trauma. Trauma screening matched with trauma-specific therapies such as exposure therapy or trauma-focused cognitive behavioral approaches should be adopted to ensure that treatments meet the needs of... includes non-residential (e.g., wraparound service planning, intensive care management, outpatient therapy...

High-ACE Low Wage Workers: Occupational Health Nursing Research and Praxis Through a Trauma-Informed Lens.

PubMed

Rosemberg, Marie-Anne; Gultekin, Laura; Pardee, Michelle

2018-05-01

Individuals with a history of adverse childhood experiences (ACEs) disproportionately have poor mental and physical health outcomes. These experiences affect individuals across the life span extending beyond health with deleterious impact on work-related outcomes. Low-wage workers are particularly at risk. Social service and health organizations are becoming aware of the extent to which the populations they serve have been affected by these experiences. Employment support programs may serve high-ACE individuals but likely are unaware of their histories and the developmental or health deficits that result and can impinge on successful employment. Occupational health nurses may be well-positioned not only to implement trauma-informed care in workplaces but also to influence the ways in which employment services for this vulnerable group are delivered. The purpose of this article is to consider how ACEs could affect vulnerable workers. The need for trauma-informed research and praxis to advance occupational health nursing is discussed.

Developing a trauma-informed, emergency department-based intervention for victims of urban violence.

PubMed

Corbin, Theodore J; Rich, John A; Bloom, Sandra L; Delgado, Dionne; Rich, Linda J; Wilson, Ann S

2011-01-01

The Surgeon General's report on youth violence, the Centers for Disease Control and Prevention, and other national organizations are calling for public health approaches to the issue of youth violence. Hospital-based violence intervention programs have shown promise in reducing recurrent violence and decreasing future involvement in the criminal justice system. These programs seldom address trauma-related symptoms. We describe a conceptual framework for emergency department-based and hospital-based violence intervention programs that intentionally addresses trauma. The intervention described--Healing Hurt People--is a trauma-informed program designed to intervene in the lives of injured patients at the life-changing moment of violent injury. This community-focused program seeks to reduce recurrent violence among 8- to 30-year-olds through opportunities for healing and connection. Healing Hurt People considers the adversity that patients have experienced during their lives and seeks to break the cycle of violence by addressing this trauma.

Satisfaction with civilian family medicine residency training: Perspectives from serving general duty medical officers in the Canadian Armed Forces.

PubMed

Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre

2016-09-01

To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Canada. General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement were identified. Many of these areas might be addressed within the context of a 2-year residency program without risking the generalist nature of family medicine training. These findings provide valuable data for residency programs that accept military trainees across the country. Copyright© the College of Family Physicians of Canada.

Prehospital traumatic cardiac arrest: the cost of futility.

PubMed

Rosemurgy, A S; Norris, P A; Olson, S M; Hurst, J M; Albrink, M H

1993-09-01

Of 12,462 trauma patients cared for by prehospital services from October 1, 1989 to March 31, 1991, 138 patients underwent CPR at the scene or during transport because of the absence of blood pressure, pulse, and respiration. Ninety-six (70%) suffered blunt trauma, 42 (30%) suffered penetrating trauma. Sixty (43%) were transported by air utilizing county-wide transport protocols. None of the patients survived. Aggregate care cost $871,186.00. In 11 cases (8%), tissue for transplantation was procured (only corneas). Trauma patients who require CPR at the scene or in transport die. Infrequent organ procurement does not seem to justify the cost (primarily borne by hospitals), consumption of resources, and exposure of health care providers to occupational health hazards. The wisdom of transporting trauma victims suffering cardiopulmonary arrest at the scene or during transport must be questioned. Allocation of resources to these patients is not an insular medical issue, but a broad concern for our society, and society should decide if the "cost of futility" is excessive.

Military Sexual Trauma

MedlinePlus

... associated with MST among users of VA health care are depression and other mood disorders, and substance use disorders. Fortunately, people can recover from experiences of trauma, and VA has effective services to help Veterans do ... VA health care system has a designated MST Coordinator who serves ...

The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients

PubMed Central

Kartha, Anand; Brower, Victoria; Saitz, Richard; Samet, Jeffrey H.; Keane, Terence M.; Liebschutz, Jane

2009-01-01

Background Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. Objectives To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. Research Design Cross-sectional study. Subjects English speaking patients at an academic, urban primary care clinic. Measures Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. Results Among 592 subjects, 80% had ≥1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1–14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9–11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4–3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4–5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1–4.1) but no increase in outpatient and emergency department visits. Conclusions PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association. PMID:18362818

Comparison of trauma care systems in Asian countries: A systematic literature review.

PubMed

Choi, Se Jin; Oh, Moon Young; Kim, Na Rae; Jung, Yoo Joong; Ro, Young Sun; Shin, Sang Do

2017-12-01

The study aims to compare the trauma care systems in Asian countries. Asian countries were categorised into three groups; 'lower middle-income country', 'upper middle-income country' and 'high-income country'. The Medline/PubMed database was searched for articles published from January 2005 to December 2014 using relevant key words. Articles were excluded if they examined a specific injury mechanism, referred to a specific age group, and/or did not have full text available. We extracted information and variables on pre-hospital and hospital care factors, and regionalised system factors and compared them across countries. A total of 46 articles were identified from 13 countries, including Pakistan, India, Vietnam and Indonesia from lower middle-income countries; the Islamic Republic of Iran, Thailand, China, Malaysia from upper middle-income countries; and Saudi Arabia, the Republic of Korea, Japan, Hong Kong and Singapore from high-income countries. Trauma patients were transported via various methods. In six of the 13 countries, less than 20% of trauma patients were transported by ambulance. Pre-hospital trauma teams primarily comprised emergency medical technicians and paramedics, except in Thailand and China, where they included mainly physicians. In Iran, Pakistan and Vietnam, the proportion of patients who died before reaching hospital exceeded 50%. In only three of the 13 countries was it reported that trauma surgeons were available. In only five of the 13 countries was there a nationwide trauma registry. Trauma care systems were poorly developed and unorganised in most of the selected 13 Asian countries, with the exception of a few highly developed countries. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network.

PubMed

Greeson, Johanna K P; Briggs, Ernestine C; Kisiel, Cassandra L; Layne, Christopher M; Ake, George S; Ko, Susan J; Gerrity, Ellen T; Steinberg, Alan M; Howard, Michael L; Pynoos, Robert S; Fairbank, John A

2011-01-01

Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.

Epidemiology of Traumatic Injuries at an Urban Hospital in Port-au-Prince, Haiti.

PubMed

Zuraik, Christopher; Sampalis, John

2017-11-01

Traumatic injuries represent a major burden of disease worldwide. Haiti lacks statistics on the epidemiology of traumatic injuries, as there is no formal injury surveillance program. This study will assess the burden of traumatic injuries in an urban trauma center in the capital city of Port-au-Prince, Haiti. A retrospective, cross-sectional chart review study at an urban trauma hospital was carried out for the period December 1, 2015, to January 31, 2016. Data were obtained through the hospital's main patient logbook, medical charts, and trauma registry forms. Data on medical documentation, demographics, and injury characteristics were collected and analyzed using descriptive statistics. A total of 410 patients were evaluated for treatment of traumatic injuries during the 2-month study. The mean age in years was 30, with 66.3% male and 78.4% less than 41 years of age. There were 6.6 injuries per day and no correlation between frequency of injury and day of the week. Road traffic accidents accounted for 43.0% of trauma modes. The mean and median length of stay were 6.6 and 3.0 days. 9.0% of patients suffered severe trauma (ISS ≥ 16). 21.0% of patients with traumatic brain injury suffered severe head injuries. Extremity trauma was the most frequently injured anatomical region (50.0%). 22.7% of patients were admitted, and 15.1% patients underwent at least one surgical procedure. Road traffic accidents are the primary reason for injury; thus, prevention initiatives and improved trauma care may provide substantial public health benefits.

Management of hip fractures pre- and post-Major Trauma Centre activation.

PubMed

Wong, Ken; Rich, James; Yip, Grace; Loizou, Constantinos; Hull, Peter

2015-10-01

In April 2012, the activation of the regional trauma networks in England was carried out to improve the organisation of trauma care. NHS Trusts that could meet the highest standard of care to complex trauma were designated Major Trauma Centres (MTCs). MTCs receive patients fulfilling certain triage criteria, as well as secondary transfers from nearby trauma units. While complex trauma care is streamlined with this new organisation, the impact this would have on the rest of the trauma workload within MTCs as well as non-MTC hospitals is uncertain. We investigate whether the management of hip fracture cases had suffered as a result of a trauma unit becoming a MTC. Summary data was collated from the National Hip Fracture Database website for the periods of April 2011-April 2012 (the 'pre-MTC' activation period) and April 2012-April 2013 (the 'post-MTC' activation period). As our primary outcome, we compared the time to surgery within 36h between MTCs and non-MTCs for the periods detailed above. Other outcome measures were: reasons for delay to surgery, length of acute stay, proportion of cases meeting Best Practice Tariff criteria. A total of 54,897 and 55,998 fNOF patients were included for all hospitals in England in the pre- and post-MTC periods respectively. For MTCs, a weighted mean average of 66.6% patients had surgery within 36h in the pre-MTC period versus 71.4% of patients in the post MTC period (p<0.0001). For non-MTCs, a weighted mean average of 70.0% of patients had surgery within 36h in the pre-MTC period versus 73.8% of patients in the post-MTC period (p<0.0001). Non-MTCs in both pre- and post-MTC activation periods were therefore better in percentage of patients receiving surgery within 36h. The data presented suggests that the creation of MTCs has not had a deleterious effect on the management of hip fracture patients. This paper aims to stimulate the important discussion of maintaining a consistently improving standard throughout the spectrum of trauma care, in conjunction with the development of regional Major Trauma Networks. Copyright © 2015 Elsevier Ltd. All rights reserved.

Major trauma from suspected child abuse: a profile of the patient pathway.

PubMed

Davies, Ffion C; Lecky, Fiona E; Fisher, Ross; Fragoso-Iiguez, Marisol; Coats, Tim J

2017-09-01

Networked organised systems of care for patients with major trauma now exist in many countries, designed around the needs of the majority of patients (90% adults). Non-accidental injury is a significant cause of paediatric major trauma and has a different injury and age profile from accidental injury (AI). This paper compares the prehospital and inhospital phases of the patient pathway for children with suspected abuse, with those accidentally injured. The paediatric database of the national trauma registry of England and Wales, Trauma Audit and Research Network, was interrogated from April 2012 (the launch of the major trauma networks) to June 2015, comparing the patient pathway for cases of suspected child abuse (SCA) with AI. In the study population of 7825 children, 7344 (94%) were classified as AI and 481 (6%) as SCA. SCA cases were younger (median 0.4 years vs 7 years for AI), had a higher Injury Severity Score (median 16vs9 for AI), and had nearly three times higher mortality (5.7%vs2.2% for AI). Other differences included presentation to hospital evenly throughout the day and year, arrival by non-ambulance means to hospital (74%) and delayed presentation to hospital from the time of injury (median 8 hours vs 1.8 hours for AI). Despite more severe injuries, these infants were less likely to receive key interventions in a timely manner. Only 20% arrived to a designated paediatric-capable major trauma centre. Secondary transfer to specialist care, if needed, took a median of 21.6 hours from injury(vs 13.8 hours for AI). These data show that children with major trauma that is inflicted rather than accidental follow a different pathway through the trauma system. The current model of major trauma care is not a good fit for the way in which child victims of suspected abuse present to healthcare. To achieve better care, awareness of this patient profile needs to increase, and trauma networks should adjust their conventional responses. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Ocular trauma in a rural south Indian population: the Aravind Comprehensive Eye Survey.

PubMed

Nirmalan, Praveen K; Katz, Joanne; Tielsch, James M; Robin, Alan L; Thulasiraj, Ravilla D; Krishnadas, Ramasamy; Ramakrishnan, Rengappa

2004-09-01

To determine the rate of ocular trauma in a rural population of southern India and its impact on vision impairment and blindness. A population-based cross-sectional study of 5150 persons 40 years or older in a randomly chosen rural population of 3 districts of southern India. Prospective information on trauma, type and agent of injury, setting of injury, and details of treatment sought for the last episode was recorded with questionnaires after face-to-face interviews. All interviewed subjects underwent a comprehensive ocular examination, including vision estimations, slit-lamp biomicroscopy examinations, and dilated posterior segment examinations. We elicited a history of ocular trauma in either eye from 229 (4.5%) persons, including 21 (0.4%) persons with bilateral ocular trauma. Blunt injuries (n = 124; 54.9%) were the major cause for trauma reported in this population. The most common setting where the ocular trauma occurred was during agricultural labor (n = 107; 46.9%). Nearly three quarters (n = 170; 74.2%) of those reporting ocular trauma sought treatment from an eye specialist (n = 104; 57.8%) and one fifth (n = 37; 20.6%) from a traditional healer. The age-adjusted (adjusted to the population estimates for India for the year 2000) prevalence for blindness in any eye caused by trauma was 0.8% (95% confidence interval [CI], 0.4-1.1). The odds ratios (OR) for trauma were higher for males (OR, 2.2; 95% CI, 1.6-3.0) and laborers (OR, 1.7; 95% CI, 1.2-2.4) and lower for literates (OR, 0.7; 95% CI, 0.5- 0.9). Seeking treatment from a traditional eye healer for trauma was not associated with vision impairment (OR, 1.0; 95% CI, 0.3-3.2) or with blindness (OR, 3.4; 95% CI, 0.2-56.5). Eye care programs may need to consider ocular trauma as a priority in this population, because the lifetime prevalence of ocular trauma is higher than that reported for glaucoma, age-related macular degeneration, or diabetic retinopathy from this population. Simple measures such as education regarding the use of protective eyewear could possibly significantly decrease this preventable cause of visual disability.

Compliance with recommended care at trauma centers: association with patient outcomes.

PubMed

Shafi, Shahid; Barnes, Sunni A; Rayan, Nadine; Kudyakov, Rustam; Foreman, Michael; Cryer, H Gil; Alam, Hasan B; Hoff, William; Holcomb, John

2014-08-01

State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. This retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity. Compliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not. Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Mobile in Situ Simulation as a Tool for Evaluation and Improvement of Trauma Treatment in the Emergency Department.

PubMed

Amiel, Imri; Simon, Daniel; Merin, Ofer; Ziv, Amitai

2016-01-01

Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully. The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention. The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005). The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams' function in various aspects of treatment. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth.

PubMed

Wong, Carolyn F; Clark, Leslie F; Marlotte, Lauren

2016-03-01

This study investigates the relative impact of trauma experiences that occurred prior to and since becoming homeless on depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and self-injurious behaviors among a sample of homeless youth (N = 389). Youth (aged 13 to 25) who had been homeless or precariously housed in the past year completed a survey about housing history, experiences of violence and victimization, mental health, and service utilization. In addition to examining the impact associated with specific trauma types, we also considered the effect of "early-on" poly-victimization (i.e., cumulative number of reported traumas prior to homelessness) and the influence of a compound sexual trauma variable created to represent earlier complex trauma. This created-variable has values ranging from no reported trauma, single trauma, multiple non-sexual traumas, and multiple traumas that co-occurred with sexual abuse. Multivariate analyses revealed that specific traumatic experiences prior to homelessness, including sexual abuse, emotional abuse/neglect, and adverse home environment, predicted greater mental health symptoms. Poly-victimization did not add to the prediction of mental health symptoms after the inclusion of specific traumas. Results with early compound sexual trauma revealed significant differences between lower-order trauma exposures and multiple-trauma exposures. Specifically, experience of multiple traumas that co-occurred with sexual trauma was significantly more detrimental in predicting PTSD symptoms than multiple traumas of non-sexual nature. Findings support the utility of an alternate/novel conceptualization of complex trauma, and support the need to carefully evaluate complex traumatic experiences that occurred prior to homelessness, which can impact the design and implementation of mental health care and services for homeless youth. © The Author(s) 2014.

Whats the story? Information needs of trauma teams.

PubMed

Sarcevic, Aleksandra; Burd, Randall S

2008-11-06

This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams.

Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

PubMed

Königs, Marsh; Beurskens, Eva A; Snoep, Lian; Scherder, Erik J; Oosterlaan, Jaap

2018-06-01

To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods. PubMed, Embase, PsycINFO, and Cochrane Database. Electronic databases were searched for prospective controlled clinical trials assessing the effect of timing or intensity of multidisciplinary neurorehabilitation programs on functional outcome of patients with moderate or severe TBI. A total of 5961 unique records were screened for relevance, of which 58 full-text articles were assessed for eligibility by 2 independent authors. Eleven articles were included for systematic review and meta-analysis. Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration tool. Discrepancies between authors were resolved by consensus. Systematic review of a total of 6 randomized controlled trials, 1 quasi-randomized trial, and 4 controlled trials revealed consistent evidence for a beneficial effect of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation in the rehabilitation facility on functional outcome compared with usual care. Meta-analytic quantification revealed a large-sized positive effect for early onset rehabilitation programs (d=1.02; P<.001; 95% confidence interval [CI], 0.56-1.47) and a medium-sized positive effect for intensive neurorehabilitation programs (d=.67; P<.001; 95% CI, .38-.97) compared with usual care. These effects were replicated based solely on studies with a low overall risk of bias. The available evidence indicates that early onset neurorehabilitation in the trauma center and more intensive neurorehabilitation in the rehabilitation facility promote functional recovery of patients with moderate to severe TBI compared with usual care. These findings support the integration of early onset and more intensive neurorehabilitation in the chain of care for patients with TBI. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Military Operating Room of the Future

DTIC Science & Technology

2011-10-01

of acute trauma care in both the civilian and military settings by introducing innovations in communication, technology, workflow, and behaviors...Surgical Errors: An Exploratory Investigation. Surgery, 2007; 142(5), 658-665. 21 | P a g e A ppendices A ppendix D ocum ent 1: Process M aps...ServiceWard Remain on           Trauma Service Remain on           Trauma Service Remain on           Trauma Service Stable for  Transfer to an  Acute  Care

A Delphi study on research priorities for trauma nursing.

PubMed

Bayley, E W; Richmond, T; Noroian, E L; Allen, L R

1994-05-01

To identify and prioritize research questions of importance to trauma patient care and of interest to trauma nurses. A three-round Delphi technique was used to solicit, identify, and prioritize problems for trauma nursing research. In round 1, experienced trauma nurses (N = 208) generated 513 problems, which were analyzed, categorized, and collapsed into 111 items for subsequent rounds. Round 2 participants rated each research question on a 1 to 7 scale on two criteria: impact on patient welfare and value for practicing nurses. Group median scores provided by 166 round 2 respondents and respondents' individual round 2 scores were indicated on the round 3 questionnaire. Subjects rated the questions again on the same criteria and indicated whether nurses, independently or in collaboration with other health professionals, should assume responsibility for that research. Median and mean scores and rank order were determined for each item. Respondents who completed all three rounds (n = 137) had a mean of 8.3 years of trauma experience. Nine research questions ranked within the top 20 on both criteria. The two research questions that ranked highest on both criteria were: What are the most effective nursing interventions in the prevention of pulmonary and circulatory complications in trauma patients? and What are the most effective methods for preventing aspiration in trauma patients during the postoperative phase? The third-ranked question regarding patient welfare was: What psychological and lifestyle changes result from traumatic injury? Regarding value for practicing nurses, What are the most effective educational methods to prepare and maintain proficiency in trauma care providers? ranked third. These research priorities provide impetus and direction for nursing and collaborative investigation in trauma care.

A population-based analysis of injury-related deaths and access to trauma care in rural-remote Northwest British Columbia.

PubMed

Simons, Richard; Brasher, Penelope; Taulu, Tracey; Lakha, Nasira; Molnar, Nadine; Caron, Nadine; Schuurman, Nadine; Evans, David; Hameed, Morad

2010-07-01

Injury rates and injury mortality rates are generally higher in rural and remote communities compared with urban jurisdictions as has been shown to be the case in the rural-remote area of Northwest (NW) British Columbia (BC). The purpose of study was to identify: (1) the place and timing of death following injury in NW BC, (2) access to and quality of local trauma services, and (3) opportunities to improve trauma outcomes. Quantitative data from demographic and geographic databases, the BC Trauma Registry, Hospital discharge abstract database, and the BC Coroner's Office, along with qualitative data from chart reviews of selected major trauma cases, and interviews with front-line trauma care providers were collated and analyzed for patients sustaining injury in NW BC from April 2001 to March 2006. The majority of trauma deaths (82%) in NW BC occur prehospital. Patients arriving alive to NW hospitals have low hospital mortality (1.0%), and patients transferring from NW BC to tertiary centers have better outcomes than matched patients achieving direct entry into the tertiary center by way of geographic proximity. Access to local trauma services was compromised by: incident discovery, limited phone service (land lines/cell), incomplete 911 emergency medical services system access, geographical and climate challenges compounded by limited transportation options, airport capabilities and paramedic training level, dysfunctional hospital no-refusal policies, lack of a hospital destination policies, and lack of system leadership and coordination. Improving trauma outcomes in this rural-remote jurisdiction requires a systems approach to address root causes of delays in access to care, focusing on improved access to emergency medical services, hospital bypass and destination protocols, improved transportation options, advanced life support transfer capability, and designated, coordinated local trauma services.

Then we all fall down: fall mortality by trauma center level.

PubMed

Roubik, Daniel; Cook, Alan D; Ward, Jeanette G; Chapple, Kristina M; Teperman, Sheldon; Stone, Melvin E; Gross, Brian; Moore, Forrest O

2017-09-01

Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity, and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. This retrospective cohort study used National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II, and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Analysis of 812,053 patients' data revealed the proportion of GLF in the National Trauma Data Bank increased 8.7% (14.1%-22.8%) over the 8 y studied. Mortality was 4.21% overall with a three-fold increase for those aged 60 y and older versus younger than 60 y (4.93% versus 1.46%, P < 0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI: 0.971-0.975) and highest for State III/IV (1.043, 95% CI: 1.041-1.044). Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests that factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability. Copyright © 2017 Elsevier Inc. All rights reserved.

Holistic self-care for rehabilitation experienced by thai buddhist trauma patients in areas of political and social unrest.

PubMed

Songwathana, Praneed; Watanasiriwanich, Wachiraya; Kitrungrote, Luppana

2013-01-01

This study describes the meaning and practice of holistic self-care for rehabilitation among Thai Buddhist trauma patients living in areas of political unrest where acts of terrorism occur. Eleven Thai Buddhist trauma patients were selected as specified. The data were collected by in-depth interviews between November 2011 and April 2012, and analyzed using the Van Manen method.Those interviewed described "holistic self-care for rehabilitation" as learning (1) to acquire a new life and (2) to bear the increased demands of care as a chronic disease. Health care responses fell into 3 categories: (1) improving physical self-sufficiency and rehabilitation by increasing muscle strength, pain management, and pressure sores; (2) improving psychological well-being by applying positive thinking, making an effort to live independently, and following a set of religious practices; and (3) finding harmony in life through caution and a willingness to adjust one's lifestyle. Although the participants seemed to adapt well to their new lifestyles, extensive support from health care professionals was necessary. This study promotes better understanding of the holistic health care experiences the survivors of trauma have as a result of an unstable political situation that includes aspects of social unrest and terrorism.

Effectiveness of regionalization of trauma care services: a systematic review.

PubMed

Vali, Y; Rashidian, A; Jalili, M; Omidvari, A H; Jeddian, A

2017-05-01

Improving trauma systems in various forms has always been an important aspect of health policy. While several papers have reported the implementation of a structured trauma system of care, research evidence on the effectiveness of such regionalization for improvement in trauma outcome is limited. Systematic review. Medline, EMbase, EconLit and Health Management Information Consortium were searched, using sensitive search terms, for interventional studies that reported a trauma regionalization system as their intervention, and compared important outcomes such as mortality and preventable deaths. At least two authors assessed eligibility for inclusion and risk of bias, and extracted data from the included studies. As meta-analysis was not possible for all studies, two controlled before-after studies were included in the meta-analysis, and a narrative analysis was conducted for the other studies. After title and abstract sifting, 66 papers were retrieved. After reading the full texts, a total of 24 studies from the USA, UK, Canada, Australia, and the Netherlands were included in this review. In spite of variation in study specifications, most were before-after studies with a high risk of bias. Although a reduction in mortality was shown in most studies, only two studies were eligible for meta-analysis, and the results showed a significant reduction in mortality after implementation of an organized trauma system (odds ratio 0.840, 95% confidence interval 0.756-0.924; P = 0.00). Correlation was found between a regionalized network of trauma care and a reduction in trauma-related mortality, based on studies that did not exclude the effects of other concurrent changes on observed reductions. It is recommended that more studies with robust research designs should be conducted in a more diverse range of countries to assess the effectiveness of regionalization. Despite this limitation, the present findings support the regionalization of trauma care services. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Implementation of a nationwide trauma network for the care of severely injured patients.

PubMed

Ruchholtz, Steffen; Lefering, Rolf; Lewan, Ulrike; Debus, Florian; Mand, Carsten; Siebert, Hartmut; Kühne, Christian A

2014-06-01

Regional differences in the care of severely injured patients remain problematic in industrial countries. In 2006, the German Society for Trauma Surgery initiated the foundation of regional networks between trauma centers in a TraumaNetwork (TNW). The TNW consisted of five major elements as follows: (a) a whitebook on the treatment of severely injured patients; (b) evidence-based guidelines (S3); (c) local audits; (d) contracts of interhospital cooperation among all participating hospitals; and (e) TraumaRegister documentation. TNW hospitals are classified according to local audit results as supraregional (STC), regional (RTC), or local (LTC) trauma centers by criteria concerning staff, equipment, admission capacity, and responsibility. Five hundred four German trauma centers (TCs) were certified by the end of December 2012. By then, 37 regional TNWs, with a mean of 13.6 TCs, were established, covering approximately 80% of the country's territory. Of the hospitals, 92 were acknowledged as STCs, 210 as RTCs, and 202 as LTCs.In 2012, 19,124 patients were documented by the certified TCs. Fifty-seven percent of the patients were treated in STCs, 34% in RTCs, and 9% in LTCs. The mean (SD) Injury Severity Score (ISS) was highest in STCs (21 [13]), compared with 18 (12) in RTCs and 16 (10) in LTCs. There were differences in expected mortality (based on Revised Injury Severity Classification) according to the differences in the severity of trauma among the different categories, but in all types, the expected mortality was significantly higher than the observed mortality (differences in STCs, 1.8%; RTCs, 1.4%; LTCs, 2.0%). According to our findings, it is possible to successfully structure and standardize the care of severely injured patients in a nationwide trauma system. Better outcomes than expected were observed in all categories of TNW hospitals. Epidemiologic study, level III. Therapeutic/care management study, level IV.

Barriers to implementing the World Health Organization's Trauma Care Checklist: A Canadian single-center experience.

PubMed

Nolan, Brodie; Zakirova, Rimma; Bridge, Jennifer; Nathens, Avery B

2014-11-01

Management of trauma patients is difficult because of their complexity and acuity. In an effort to improve patient care and reduce morbidity and mortality, the World Health Organization developed a trauma care checklist. Local stakeholder input led to a modified 16-item version that was subsequently piloted. Our study highlights the barriers and challenges associated with implementing this checklist at our hospital. The checklist was piloted over a 6-month period at St. Michael's Hospital, a Level 1 trauma center in Toronto, Canada. At the end of the pilot phase, individual, semistructured interviews were held with trauma team leaders and nursing staff regarding their experiences with the checklist. Axial coding was used to create a typology of attitudes and barriers toward the checklist, and then, vertical coding was used to further explore each identified barrier. Checklist compliance was assessed for the first 7 months. Checklist compliance throughout the pilot phase was 78%. Eight key barriers to implementing the checklist were identified as follows: perceived lack of time for the use of the checklist in critically ill patients, unclear roles, no memory trigger, no one to enforce completion, not understanding its importance or purpose, difficulty finding physicians at the end of resuscitation, staff/trainee changes, and professional hierarchy. The World Health Organization Trauma Care Checklist was a well-received tool; however, consideration of barriers to the implementation and staff adoption must be done for successful integration, with special attention to its use in critically ill patients. Therapeutic/care management, level V.

Increased Health Care Utilization and Costs Among Veterans With a Positive Screen for Military Sexual Trauma.

PubMed

Brignone, Emily; Gundlapalli, Adi V; Blais, Rebecca K; Kimerling, Rachel; Barrett, Tyson S; Nelson, Richard E; Carter, Marjorie E; Samore, Matthew H; Fargo, Jamison D

2017-09-01

The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and $10,734 among women, and 33.5 encounters and $11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and $4803 among women, and 19.5 encounters and $8001 among men. Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.

Critical care considerations in the management of the trauma patient following initial resuscitation

PubMed Central

2012-01-01

Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients. PMID:22989116

The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital.

PubMed

Tan, Timothy Xin Zhong; Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock; Wong, Ting Hway

2016-01-01

For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7-207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department.

Relational coordination promotes quality of chronic care delivery in Dutch disease-management programs.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2012-01-01

Previous studies have shown that relational coordination is positively associated with the delivery of hospital care, acute care, emergency care, trauma care, and nursing home care. The effect of relational coordination in primary care settings, such as disease-management programs, remains unknown. This study examined relational coordination between general practitioners and other professionals in disease-management programs and assessed the impact of relational coordination on the delivery of chronic illness care. Professionals (n = 188; response rate = 57%) in 19 disease-management programs located throughout the Netherlands completed surveys that assessed relational coordination and chronic care delivery. We used a cross-sectional study design. Our study demonstrated that the delivery of chronic illness care was positively related to relational coordination. We found positive relationships with community linkages (r = .210, p < .01), self-management support (r = .217, p < .01), decision support (r = .190, p < .01), delivery system design (r = .278, p < .001), and clinical information systems (r = .193, p < .01). Organization of the health delivery system was not significantly related to relational coordination. The regression analyses showed that even after controlling for all background variables, relational coordination still significantly affected chronic care delivery (β = .212, p ≤ .01). As expected, our findings showed a lower degree of relational coordination among general practitioners than between general practitioners and other core disease-management team members: practice nurses (M = 2.69 vs. 3.73; p < .001), dieticians (M = 2.69 vs. 3.07; p < .01), physical therapists (M = 2.69 vs. 3.06; p < .01), medical specialists (M = 2.69 vs. 3.16; p < .01), and nurse practitioners (M = 2.69 vs. 3.19; p < .001). The enhancement of relational coordination among core disease-management professionals with different disciplines is expected to improve chronic illness care delivery.

Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels

PubMed Central

Razzak, Junaid A; Baqir, Syed M; Khan, Uzma Rahim; Heller, David; Bhatti, Junaid; Hyder, Adnan A

2015-01-01

Background The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan. Method We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO’s Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument. Results Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses. Conclusions The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care. PMID:24157684

Placement Instability Among Young People Removed from Their Original Family and the Likely Mental Health Implications.

PubMed

Rice, Simon; Cotton, Sue; Moeller-Saxone, Kristen; Mihalopoulos, Cathrine; Magnus, Anne; Harvey, Carol; Humphreys, Cathy; Halperin, Stephen; Scheppokat, Angela; McGorry, Patrick; Herrman, Helen

2017-04-25

Young people in out-of-home care are more likely to experience poorer mental and physical health outcomes related to their peers. Stable care environments are essential for ameliorating impacts of disruptive early childhood experiences, including exposure to psychological trauma, abuse and neglect. At present there are very few high quality data regarding the placement stability history of young people in out-of-home care in Australia or other countries. To undertake the first systematic census of background, care type and placement stability characteristics of young people living in the out-of-home care sector in Australia. Data was collected from four non-government child and adolescent community service organisations located across metropolitan Melbourne in 2014. The sample comprised 322 young people (females 52.8%), aged between 12 - 17 years (mean age=14.86 [SD =1.63] years). Most young people (64.3%) were in home-based care settings (i.e., foster care, therapeutic foster care, adolescent care program, kinship care, and lead tenant care), relative to residential care (35.7%). However, the proportion in residential care is very high in this age group when compared with all children in out-of-home care (5%). Mean age of first removal was 9 years (SD =4.54). No gender differences were observed for care type characteristics. Three quarters of the sample (76.9%) had a lifetime history of more than one placement in the out-of-home care system, with more than a third (36.5%) having experienced ≥5 lifetime placements. Relative to home-based care, young people in residential care experienced significantly greater placement instability (χ 2 =63.018, p <0.001). Placement instability is common in the out-of-home care sector. Given stable care environments are required to ameliorate psychological trauma and health impacts associated with childhood maltreatment, well-designed intervention-based research is required to enable greater placement stability, including strengthening the therapeutic capacities of out-of-home carers of young people.

Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment.

PubMed

Covington, Stephanie S; Burke, Cynthia; Keaton, Sandy; Norcott, Candice

2008-11-01

There is growing recognition of the complex needs of women with dual diagnoses of substance abuse and mental health disorders. Recent research indicates that 55% to 99% of women with co-occurring disorders have experienced trauma from abuse and that abused women tend to engage in self-destructive behaviors. These women often are not well served by the services found in their communities, which separate substance abuse and mental health programs, despite the fact that research shows that integrated, trauma-informed treatment services will increase the success of their recovery. A recent study examined the use of two gender-responsive, trauma-informed curricula presented in a residential facility for women, 55% of whom had criminal histories. Helping Women Recover and Beyond Trauma are both manualized programs founded on research and clinical practice and are grounded in the theories of addiction, trauma, and women's psychological development. This treatment model is named "Women's Integrated Treatment" (WIT). Women who successfully completed the programs were assessed at several points in time on several scales, including trauma symptomology, depression, and substance use before and after the programs. The findings indicated less substance use, less depression, and fewer trauma symptoms (p < or = .05)--including anxiety, sleep disturbances, and dissociation--after participation in the WIT curricula.

Characterizing Time in Longitudinal Trauma Research

PubMed Central

King, Daniel W.; King, Lynda A.; McArdle, John J.; Grimm, Kevin; Jones, Russell T.; Ollendick, Thomas H.

2006-01-01

Despite the proliferation of longitudinal trauma research, careful attention to timing of assessments is often lacking. Patterns in timing of assessments, alternative time structures, and the treatment of time as an outcome are discussed and illustrated using trauma data. PMID:16612827

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center.

PubMed

Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J

2011-03-01

Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (P<0.001). Acute care in organized SCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

Addressing alcohol-impaired driving : training physicians to detect and counsel their patients who drink heavily

DOT National Transportation Integrated Search

2000-07-01

Alcohol is the most common chronic disease in trauma patients, and one of the most common in patients treated in primary care. Studies have shown that brief counseling intervention in trauma centers and primary care clinics are efficient in reducing ...

The influence of gender on suicidal ideation following military sexual trauma among Veterans in the Veterans Health Administration.

PubMed

Monteith, Lindsey L; Bahraini, Nazanin H; Matarazzo, Bridget B; Gerber, Holly R; Soberay, Kelly A; Forster, Jeri E

2016-10-30

No studies have examined whether military sexual trauma, as measured and defined within the Veterans Health Administration (VHA), is associated with suicidal ideation among Veterans in VHA care, when taking prior suicide attempts into account. Research regarding the role of gender in this association is also limited. The present study examined: (1) whether military sexual trauma was associated with the presence of past-week suicidal ideation among 354 Veterans in VHA (310 men, 44 women); (2) whether gender moderated the association between military sexual trauma and suicidal ideation. Information regarding military sexual trauma, suicidal ideation, suicide attempt, and psychiatric diagnoses was obtained from self-report instruments and medical records. Adjusting for age, gender, combat, posttraumatic stress disorder, depressive disorders, negative affect, and lifetime suicide attempt, Veterans with military sexual trauma were significantly more likely to report suicidal ideation, compared to Veterans without military sexual trauma. Furthermore, the association between military sexual trauma and suicidal ideation was stronger for men compared to women. These results contribute to a growing literature identifying military sexual trauma as a risk factor for suicidal thoughts and behaviors among Veterans in VHA care and emphasize the importance of screening for suicidal ideation among survivors of military sexual trauma. Published by Elsevier Ireland Ltd.

A Program for Clinical Care in Physical Trauma.

DTIC Science & Technology

1981-03-01

effects obser- ved in intravenous feeding after injury;(2) The use of isotopes of nitrogen and hydrogen in substrate research in man;(3) The patho...Tactical Problems Addressed and Summary of Findings 1. Caloric Support for Protein Synthesis and Intravenous Feeding Findings: The addition of calorie...12, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24) 2. Peripheral versus Central Vein Infusion Sites for Intravenous Feeding in the Wounded, Starved, or

A Program for Clinical Care in Physical Trauma.

DTIC Science & Technology

1981-08-01

of the leg. This model increases the release of skeletal muscle amino acids, fails to develop ketosis during starvation and injury/infection, and...develop ketosis following starvation during this stress. This model has great benefit to evaluate therapies that would reverse the marked catabolic...appears to be the lack of ketosis that occurs in the starved animals that are also infected (Table I). This response is also associated with a marked fall

Splenic injury after blunt abdominal trauma during a soccer (football) game.

PubMed

Padlipsky, Patricia S; Brindis, Seth; Young, Kelly D

2014-10-01

The spleen is the most commonly injured abdominal organ in children who sustain blunt abdominal trauma, and pediatric splenic injury may result from minor mechanisms of injury, including sports participation. We present 2 cases of splenic injury in soccer goalies because of blunt abdominal trauma sustained during game play. Although abdominal organ injuries are uncommon in soccer, emergency medicine and primary care physicians must be aware of the possibility. A high index of suspicion and careful physical examination are key in making the diagnosis.

Re: Coagulation and Fluid Resuscitation by HyperHES in Severe Hemorrhage

DTIC Science & Technology

2013-08-01

aid kit, and we cannot envisage to load them with so much weight. In the context of trauma combat casualty care, fluid resuscitation byHyperHES...coagulation following femur injury and severe hemorrhage in pigs. J Trauma Acute Care Surg. 2013; 74(3):732Y740. 2. Dubick MA, Atkins JL. Small-volume...fluid resuscitation for the far-forward combat envi- ronment: current concepts. J Trauma . 2003;54: S43YS45. 3. Sharma P, Benford B, Karaian JE

The Significance of Splenectomy in Experimental Swine Models of Controlled Hemorrhagic Shock

DTIC Science & Technology

2013-11-01

carefully eval uated in other experimental models of hem orrhage (e.g., uncontrolled hemorrhage, models with concomitant blunt or orthopedic trauma , and...hemorrhagic shock. J Trauma . 2006;61(1):75 81. 3. Pottecher J, Chemla D, Xavier L, et al. The pulse pressure/heart rate ratio as a marker of stroke volume...changes during hemorrhagic shock and resuscitation in anesthetized swine. J Trauma Acute Care Surg. 2013;74(6):1438 1445. 4.Devlin JJ, Kircher SJ

“What’s the Story?” Information Needs of Trauma Teams

PubMed Central

Sarcevic, Aleksandra; Burd, Randall S.

2008-01-01

This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams. PMID:18999288

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program

PubMed Central

WIEBE, DOUGLAS J.; HOLENA, DANIEL N.; DELGADO, M. KIT; McWILLIAMS, NATHAN; ALTENBURG, JULIET; CARR, BRENDAN G.

2018-01-01

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance. PMID:28541852

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program.

PubMed

Wiebe, Douglas J; Holena, Daniel N; Delgado, M Kit; McWilliams, Nathan; Altenburg, Juliet; Carr, Brendan G

2017-05-01

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.

The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients.

PubMed

Helling, Thomas S; Nelson, Paul W; Shook, John W; Lainhart, Kathy; Kintigh, Denise

2003-07-01

The presence of a surgeon at the initial assessment and care of the trauma patient has been the focal point of trauma center designation. However, for Level I verification, the American College of Surgeons Committee on Trauma currently does not require the presence of an attending trauma surgeon in the hospital (IH), provided senior surgical residents are immediately available. Likewise, the state of Missouri does not mandate an IH presence of the attending trauma surgeon but requires senior (postgraduate year 4 or 5) level surgical residents to immediately respond, with a 20-minute response time mandated for the attending surgeon if IH or out of the hospital (OH). Nevertheless, some claim that IH coverage by attending surgeons provides better care for seriously injured patients. This retrospective study assessed patient care parameters over the past 10 years on critically injured patients to detect any difference in outcome whether the surgeon was IH or OH at the time of the trauma team activation (cardiopulmonary instability, Glasgow Coma Scale [GCS] score < 9, penetrating truncal injury). Patients were subcategorized into blunt/penetrating, shock (systolic blood pressure < 90 mm Hg) on arrival, GCS score < 9, Injury Severity Score (ISS) > 15, or ISS > 25. Response was examined from 8 am to 6 pm weekdays (IH) or 6 pm to 8 am weekdays and all weekends (OH). Patient care parameters examined were mortality, complications, time in the emergency department, time to the operating room, time to computed tomographic scanning, intensive care unit length of stay (LOS), and hospital LOS. For all patients (n = 766), there was no significant difference in any parameters except intensive care unit LOS (IH, 4.90 +/- 7.96 days; OH, 3.58 +/- 7.69 days; p < 0.05). For blunt trauma (n = 369), emergency department time was shorter (99.71 +/- 88.26 minutes vs. 126.51 +/- 96.68 minutes, p < 0.01) and hospital LOS was shorter (8.04 +/- 1.02 days vs. 11.08 +/- 1.15 days, p < 0.05) for OH response. For penetrating trauma (n = 377), shock (n = 187), GCS score < 9 (n = 248), ISS > 15 (n = 363), and ISS > 25 (n = 230), there were no statistically significant differences in any patient care parameter between IH and OH response. For those in most need of urgent operation-penetrating injuries and shock-there were no differences in time to operating room or mortality for OH or IH response. As long as initial assessment and care is provided by senior level IH surgical residents and as long as the attending surgeon responds in a defined period of time (if OH) to guide critical decision-making, the IH presence of an attending surgeon has not been shown in this retrospective study to improve care of the critically injured patient.

Ocular trauma in a rural population of southern India: the Andhra Pradesh Eye Disease Study.

PubMed

Krishnaiah, Sannapaneni; Nirmalan, Praveen K; Shamanna, Bindiganavale R; Srinivas, Marmamula; Rao, Gullapalli N; Thomas, Ravi

2006-07-01

To determine the prevalence of ocular trauma and proportion of blindness and visual impairment due to ocular trauma in a rural population of southern India. Population-based cross-sectional epidemiological study. A total of 7771 subjects of all ages, representative of the rural population of Andhra Pradesh. The subjects underwent a detailed interview and comprehensive ocular evaluation as part of the population-based Andhra Pradesh Eye Disease Study. An eye was considered to be blind due to trauma if best-corrected distance visual acuity was worse than 6/60 and the cause was attributed to ocular trauma. A total of 824 (10.6%) subjects gave a history of ocular trauma in either eye, including 76 (1.0%) persons reporting trauma in both eyes. The overall age- and gender-adjusted prevalence of history of eye injury in this rural population was 7.5% (95% confidence interval [CI], 7.0%-8.1%). Men were more likely to have an eye injury than women (odds ratio [OR], 2.1 [95% CI, 1.8-2.5]). After adjusting for gender and other demographic factors, ocular trauma was significantly more frequent among laborers (OR, 1.5 [95% CI, 1.2-1.7]) when compared with other occupational groups. After adjusting for gender, injury with vegetable matter such as a thorn, branch of a tree, plant secretion, etc. (n = 373 [45.3%]) was the major cause of trauma reported in this population. The majority of the eye injuries occurred at the workplace (n = 461 [55.9%]), followed by home (n = 179 [21.7%]). The majority of those affected (n = 806 [97.8%]) did not wear any eye protection at the time of trauma. A significant proportion (n = 307 [43.1%]) of subjects who sought treatment for an eye injury went to an ophthalmologist. Trauma was responsible for unilateral blindness in 39 subjects, an age- and gender-adjusted prevalence of 0.6% (95% CI, 0.4%-0.8%). Most ocular injuries in this rural population occurred at the workplace, suggesting the need to explore workplace strategies to minimize ocular trauma as a priority. Eye care programs targeting high-risk ocular trauma groups may need to consider ocular trauma as a priority in eye health awareness strategies to reduce blindness due to trauma.

Operation CeaseFire-New Orleans: an infectious disease model for addressing community recidivism from penetrating trauma.

PubMed

McVey, Erin; Duchesne, Juan C; Sarlati, Siavash; O'Neal, Michael; Johnson, Kelly; Avegno, Jennifer

2014-07-01

CeaseFire, using an infectious disease approach, addresses violence by partnering hospital resources with the community by providing violence interruption and community-based services for an area roughly composed of a single city zip code (70113). Community-based violence interrupters start in the trauma center from the moment penetrating trauma occurs, through hospital stay, and in the community after release. This study interprets statistics from this pilot program, begun May 2012. We hypothesize a decrease in penetrating trauma rates in the target area compared with others after program implementation. This was a 3-year prospective data collection of trauma registry from May 2010 to May 2013. All intentional, target area, penetrating trauma treated at our Level I trauma center received immediate activation of CeaseFire personnel. Incidences of violent trauma and rates of change, by zip code, were compared with the same period for 2 years before implementation. During this period, the yearly incidence of penetrating trauma in Orleans Parish increased. Four of the highest rates were found in adjacent zip codes: 70112, 70113, 70119, and 70125. Average rates per 100,000 were 722.7, 523.6, 286.4, and 248, respectively. These areas represent four of the six zip codes citywide that saw year-to-year increases in violent trauma during this period. Zip 70113 saw a lower rate of rise in trauma compared with 70112 and a higher but comparable rise compared with that of 70119 and 70125. Hospital-based intervention programs that partner with culturally appropriate personnel and resources outside the institution walls have potential to have meaningful impact over the long term. While few conclusions of the effect of such a program can be drawn in a 12-month period, we anticipate long-term changes in the numbers of penetrating injuries in the target area and in the rest of the city as this program expands. Therapeutic study, level IV.

Military Medical Revolution: Deployed Hospital and En Route Care

DTIC Science & Technology

2012-01-01

Coagulopathy, hypothermia and acidosis in trauma patients: the rationale for damage control surgery. Acta Chir Belg. 2002;102:313 316. 5...casualties. J Trauma. 2008;64(Suppl 2):S136 S144; discus- sion S144 135. 81. Higgins RA. MEDEVAC critical care transport from the battlefield. AACN Adv Crit

Post-Ocular Trauma Corneal Staphyloma in a Child Living in an Underdeveloped Region of Eastern Indonesia

PubMed Central

Sitompul, Ratna; Kusumowidagdo, Gladys; Matiur, Eiko B.; Barliana, Julie D.; Sitorus, Rita S.; Sungkar, Saleha

2018-01-01

Ocular trauma occurring in children often leads to visual impairment or blindness when it is not properly managed. This often occurs in underdeveloped regions with difficult access to professional care at local health facilities. We report a case of post-trauma corneal staphyloma in an underdeveloped region of eastern Indonesia to illustrate the importance of proper management of ocular trauma in areas lacking such expertise and where patients have difficulty accessing even basic health care. During a community health outreach in Southwest Sumba, eastern Indonesia in May 2017, a 7-year-old boy presented with white protrusion of the left eye of 3 years' duration following an event of sharp trauma. The patient lived in an inaccessible and impoverished area. Upon contemporary examination, visual acuity of the left eye was 1/300 while that of the right eye was 6/6. Anterior examination revealed corneal staphyloma of the left eye, and its posterior segment could not be evaluated. The patient was transported to an eye care center in Jakarta, receiving a stock prosthesis implant while awaiting a corneal evisceration procedure with dermofat graft. Ocular trauma is one of the most common causes of visual impairment in children. This case illustrates the consequences of inadequate post-trauma management and the importance of prevention of infection. PMID:29681830

Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.

PubMed

Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

2014-01-01

Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p<0.001). This multicentre trauma costing study demonstrated the feasibility of trauma registry and financial data linkage. Discrepancies between the observed costs of care in these 12 trauma centres and the NSW average AR-DRG costs suggest that trauma care is currently underfunded in NSW. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

[Resources and capacity of emergency trauma care services in Peru].

PubMed

Rosales-Mayor, Edmundo; Miranda, J Jaime; Lema, Claudia; López, Luis; Paca-Palao, Ada; Luna, Diego; Huicho, Luis

2011-09-01

The objectives of this study were to evaluate the resources and capacity of emergency trauma care services in three Peruvian cities using the WHO report Guidelines for Essential Trauma Care. This was a cross-sectional study in eight public and private healthcare facilities in Lima, Ayacucho, and Pucallpa. Semi-structured questionnaires were applied to the heads of emergency departments with managerial responsibility for resources and capabilities. Considering the profiles and volume of care in each emergency service, most respondents in all three cities classified their currently available resources as inadequate. Comparison of the health facilities showed a shortage in public services and in the provinces (Ayacucho and Pucallpa). There was a widespread perception that both human and physical resources were insufficient, especially in public healthcare facilities and in the provinces.

Evaluation of SOCOM Wireless Monitor in Trauma Patients

DTIC Science & Technology

2015-02-01

DOD Award W81XWH-11-2-0098 page 7 Do all trauma patients benefit from tranexamic acid ? J Trauma Acute Care Surg 2014...2015 11) Valle EJ, Allen CJ, Van Haren RM, Jouria JM, Li H, Livingstone AS, Proctor KG: Tranexamic acid may have undesirable actions in some trauma...Livingstone AS, Proctor KG: Do all patients benefit from tranexamic acid ? The experience of an urban level 1 trauma center. Presented at 72nd Annual

Access to specialist care: Optimizing the geographic configuration of trauma systems.

PubMed

Jansen, Jan O; Morrison, Jonathan J; Wang, Handing; He, Shan; Lawrenson, Robin; Hutchison, James D; Campbell, Marion K

2015-11-01

The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system. This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations. A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals. This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland's trauma system could be optimized with one or two MTCs. Care management study, level IV.

Postpartum Perineal Pain in a Low Episiotomy Setting: Association with Severity of Genital Trauma, Labor Care and Birth Variables

PubMed Central

Leeman, Lawrence; Fullilove, Anne M.; Borders, Noelle; Manocchio, Regina; Albers, Leah L.; Rogers, Rebecca G.

2013-01-01

Background Perineal pain is common after childbirth. We studied the effect of genital tract trauma, labor care, and birth variables on the incidence of pain in a population of healthy women exposed to low rates of episiotomy and operative delivery. Methods A prospective study of genital trauma at birth and assessment of postpartum perineal pain and analgesic use was conducted in 565 midwifery patients. Perineal pain was assessed using the Present Pain Intensity (PPI) and Visual Analog Scale (VAS) components of the validated short form McGill pain scale. Multivariate logistic regression examined which patient characteristics or labor care measures were significant determinants of perineal pain and use of analgesic medicines. Results At hospital discharge, women with major trauma reported higher VAS pain scores (2.16 +/− 1.61 vs 1.48 +/− 1.40; P< 0.001) and were more likely to use analgesic medicines (76.3 vs 23.7%, P= 0.002) than women with mild or no trauma. By 3 months average VAS scores were low in each group and not significantly different. Perineal pain at the time of discharge was associated in univariate analysis with higher education level, ethnicity (non-Hispanic white), nulliparity, and longer length of active maternal pushing efforts. In a multivariate model only trauma group and length of active pushing predicted pain at hospital discharge. In women with minor or no trauma, only length of the active part of second stage labor had a positive relationship with pain. In women with major trauma, the length of active second stage labor had no independent effect on level of pain at discharge beyond its effect on the incidence of major trauma. Conclusions Women with spontaneous perineal trauma reported very low rates of postpartum perineal pain. Women with major trauma reported increased perineal pain compared with women who had no or minor trauma; however, by 3 months postpartum this difference was no longer present. In women with minor or no perineal trauma, a longer period of active pushing was associated with increased perineal pain. PMID:20002420

Influence of podiatry on orthopedic surgery at a level I trauma center.

PubMed

Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J

2014-06-01

Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent. Copyright 2014, SLACK Incorporated.

Donabedian's structure-process-outcome quality of care model: Validation in an integrated trauma system.

PubMed

Moore, Lynne; Lavoie, André; Bourgeois, Gilles; Lapointe, Jean

2015-06-01

According to Donabedian's health care quality model, improvements in the structure of care should lead to improvements in clinical processes that should in turn improve patient outcome. This model has been widely adopted by the trauma community but has not yet been validated in a trauma system. The objective of this study was to assess the performance of an integrated trauma system in terms of structure, process, and outcome and evaluate the correlation between quality domains. Quality of care was evaluated for patients treated in a Canadian provincial trauma system (2005-2010; 57 centers, n = 63,971) using quality indicators (QIs) developed and validated previously. Structural performance was measured by transposing on-site accreditation visit reports onto an evaluation grid according to American College of Surgeons criteria. The composite process QI was calculated as the average sum of proportions of conformity to 15 process QIs derived from literature review and expert opinion. Outcome performance was measured using risk-adjusted rates of mortality, complications, and readmission as well as hospital length of stay (LOS). Correlation was assessed with Pearson's correlation coefficients. Statistically significant correlations were observed between structure and process QIs (r = 0.33), and process and outcome QIs (r = -0.33 for readmission, r = -0.27 for LOS). Significant positive correlations were also observed between outcome QIs (r = 0.37 for mortality-readmission; r = 0.39 for mortality-LOS and readmission-LOS; r = 0.45 for mortality-complications; r = 0.34 for readmission-complications; 0.63 for complications-LOS). Significant correlations between quality domains observed in this study suggest that Donabedian's structure-process-outcome model is a valid model for evaluating trauma care. Trauma centers that perform well in terms of structure also tend to perform well in terms of clinical processes, which in turn has a favorable influence on patient outcomes. Prognostic study, level III.

Minimizing pediatric healthcare-induced anxiety and trauma

PubMed Central

Lerwick, Julie L

2016-01-01

Frequently, episodes of care such as preventive clinic visits, acute care, medical procedures, and hospitalization can be emotionally threatening and psychologically traumatizing for pediatric patients. Children are often subject to psychological trauma, demonstrated by anxiety, aggression, anger, and similar expressions of emotion, because they lack control of their environment. This sense of helplessness, coupled with fear and pain can cause children to feel powerless in healthcare settings. These emotional responses can delay important medical treatment, take more time to complete and can reduce patient satisfaction. Healthcare professionals are uniquely positioned to prevent healthcare-induced trauma and reduce healthcare-induced anxiety. This article introduces a new way to choice, agenda, resilience and emotion (CARE) for pediatric patients in the healthcare setting by implementing the four following treatment principles called the care process: (1) Choices: Offer power in a powerless environment; (2) Agenda: Let patients and families know what to expect and what is expected of them; (3) Resilience: Highlight strengths and reframe negatives; and (4) Emotional support: Recognize and normalize common fears and responses. Engaging the CARE principles helps patients and families feel empowered and mitigates, reduces, and may even ameliorate risk of anxiety and trauma responses. PMID:27170924

Minimizing pediatric healthcare-induced anxiety and trauma.

PubMed

Lerwick, Julie L

2016-05-08

Frequently, episodes of care such as preventive clinic visits, acute care, medical procedures, and hospitalization can be emotionally threatening and psychologically traumatizing for pediatric patients. Children are often subject to psychological trauma, demonstrated by anxiety, aggression, anger, and similar expressions of emotion, because they lack control of their environment. This sense of helplessness, coupled with fear and pain can cause children to feel powerless in healthcare settings. These emotional responses can delay important medical treatment, take more time to complete and can reduce patient satisfaction. Healthcare professionals are uniquely positioned to prevent healthcare-induced trauma and reduce healthcare-induced anxiety. This article introduces a new way to choice, agenda, resilience and emotion (CARE) for pediatric patients in the healthcare setting by implementing the four following treatment principles called the care process: (1) Choices: Offer power in a powerless environment; (2) Agenda: Let patients and families know what to expect and what is expected of them; (3) Resilience: Highlight strengths and reframe negatives; and (4) Emotional support: Recognize and normalize common fears and responses. Engaging the CARE principles helps patients and families feel empowered and mitigates, reduces, and may even ameliorate risk of anxiety and trauma responses.

Early Intervention for Families Exposed to Chronic Stress and Trauma: The Attachment Vitamins Program

ERIC Educational Resources Information Center

Hulette, Annmarie C.; Dunham, Mackenzie; Davis, Mindy; Gortney, Jason; Lieberman, Alicia F.

2016-01-01

This article describes the Attachment Vitamins program, a trauma-informed parent group intervention for families with young children. Attachment Vitamins is a relational psychoeducational intervention based on the principles of Child-Parent Psychotherapy (CPP). Its goal is to repair the impact of chronic stress and trauma through strengthening the…

Randomized Control Trial of a CBT Trauma Recovery Program in Palestinian Schools

ERIC Educational Resources Information Center

Barron, Ian G.; Abdallah, Ghassan; Smith, Patrick

2013-01-01

The current study aimed to assess the Teaching Recovery Techniques (TRT) trauma recovery program within the context of ongoing violence. Utilizing a randomized controlled trial, 11-14-year-old students in Nablus, Palestine, were allocated by class to intervention or wait-list control conditions. Standardized measures assessed trauma exposure,…

Real money: complications and hospital costs in trauma patients.

PubMed

Hemmila, Mark R; Jakubus, Jill L; Maggio, Paul M; Wahl, Wendy L; Dimick, Justin B; Campbell, Darrell A; Taheri, Paul A

2008-08-01

Major postoperative complications are associated with a substantial increase in hospital costs. Trauma patients are known to have a higher rate of complications than the general surgery population. We used the National Surgical Quality Improvement Program (NSQIP) methodology to evaluate hospital costs, duration of stay, and payment associated with complications in trauma patients. Using NSQIP principles, patient data were collected for 512 adult patients admitted to the trauma service for > 24 hours at a Level 1 trauma center (2004-2005). Patients were placed in 1 of 3 groups: no complications (none), >or=1 minor complication (minor, eg, urinary tract infection), or >or=1 major complication (major, eg, pneumonia). Total hospital charges, costs, payment, and duration of stay associated with each complication group were determined from a cost-accounting database. Multiple regression was used to determine the costs of each type of complication after adjusting for differences in age, sex, new injury severity score, Glasgow coma scale score, maximum head abbreviated injury scale, and first emergency department systolic blood pressure. A total of 330 (64%) patients had no complications, 53 (10%) had >or= 1 minor complication, and 129 (25%) had >or= 1 major complication. Median hospital charges increased from $33,833 (none) to $81,936 (minor) and $150,885 (major). The mean contribution to margin per day was similar for the no complication and minor complication groups ($994 vs $1,115, P = .7). Despite higher costs, the patients in the major complication group generated a higher mean contribution to margin per day compared to the no complication group ($2,168, P < .001). The attributable increase in median total hospital costs when adjusted for confounding variables was $19,915 for the minor complication group (P < .001), and $40,555 for the major complication group (P < .001). Understanding the costs associated with traumatic injury provides a window for assessing the potential cost reductions associated with improved quality care. To optimize system benefits, payers and providers should develop integrated reimbursement methodologies that align incentives to provide quality care.

Tele-Pediatric Intensive Care for Critically Ill Children in Syria.

PubMed

Ghbeis, Muhammad Bakr; Steffen, Katherine M; Braunlin, Elizabeth A; Beilman, Gregory J; Dahman, Jay; Ostwani, Waseem; Steiner, Marie E

2017-12-12

Armed conflicts can result in humanitarian crises and have major impacts on civilians, of whom children represent a significant proportion. Usual pediatric medical care is often disrupted and trauma resulting from war-related injuries is often devastating. High pediatric mortality rates are thus experienced in these ravaged medical environments. Using simple communication technology to provide real-time management recommendations from highly trained pediatric personnel can provide substantive clinical support and have a significant impact on pediatric morbidity and mortality. We implemented a "Tele-Pediatric Intensive Care" program (Tele-PICU) to provide real-time management consultation for critically ill and injured pediatric patients in Syria with intensive care needs. Over the course of 7 months, 19 cases were evaluated, ranging in age from 1 day to 11 years. Consultation questions addressed a wide range of critical care needs. Five patients are known to have survived, three were transferred, five died, and six outcomes were unknown. Based on this limited undertaking with its positive impact on survival, further development of Tele-PICU-based efforts with attention to implementation and barriers identified through this program is desirable. Even limited Tele-PICU can provide timely and potentially lifesaving assistance to pediatric care providers. Future efforts are encouraged.

Non-traumatic hemorrhage is controlled with REBOA in acute phase then mortality increases gradually by non-hemorrhagic causes: DIRECT-IABO registry in Japan.

PubMed

Matsumura, Y; Matsumoto, J; Idoguchi, K; Kondo, H; Ishida, T; Kon, Y; Tomita, K; Ishida, K; Hirose, T; Umakoshi, K; Funabiki, T

2017-08-22

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is now a feasible and less invasive resuscitation procedure. This study aimed to compare the clinical course of trauma and non-trauma patients undergoing REBOA. Patient demographics, etiology, bleeding sites, hemodynamic response, length of critical care, and cause of death were recorded. Characteristics and outcomes were compared between non-trauma and trauma patients. Kaplan-Meier survival analysis was then conducted. Between August 2011 and December 2015, 142 (36 non-trauma; 106 trauma) cases were analyzed. Non-traumatic etiologies included gastrointestinal bleeding, obstetrics and gynecology-derived events, visceral aneurysm, abdominal aortic aneurysm, and post-abdominal surgery. The abdomen was a common bleeding site (69%), followed by the pelvis or extra-pelvic retroperitoneum. None of the non-trauma patients had multiple bleeding sites, whereas 45% of trauma patients did (P < 0.001). No non-trauma patients required resuscitative thoracotomy compared with 28% of the trauma patients (P < 0.001). Non-trauma patients presented a lower 24-h mortality than trauma patients (19 vs. 51%, P = 0.001). The non-trauma cases demonstrated a gradual but prolonged increased mortality, whereas survival in trauma cases rapidly declined (P = 0.009) with similar hospital mortality (68 vs. 64%). Non-trauma patients who survived for 24 h had 0 ventilator-free days and 0 ICU-free days vs. a median of 19 and 12, respectively, for trauma patients (P = 0.33 and 0.39, respectively). Non-hemorrhagic death was more common in non-trauma vs. trauma patients (83 vs. 33%, P < 0.001). Non-traumatic hemorrhagic shock often resulted from a single bleeding site, and resulted in better 24-h survival than traumatic hemorrhage among Japanese patients who underwent REBOA. However, hospital mortality increased steadily in non-trauma patients affected by non-hemorrhagic causes after a longer period of critical care.

The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital

PubMed Central

Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock

2016-01-01

Background For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. Methods From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Results Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7–207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Conclusion Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department. PMID:27136299

Helicopter overtriage in pediatric trauma.

PubMed

Michailidou, Maria; Goldstein, Seth D; Salazar, Jose; Aboagye, Jonathan; Stewart, Dylan; Efron, David; Abdullah, Fizan; Haut, Elliot R

2014-11-01

Helicopter Emergency Medical Services (HEMS) have been designed to provide faster access to trauma center care in cases of life-threatening injury. However, the ideal recipient population is not fully characterized, and indications for helicopter transport in pediatric trauma vary dramatically by county, state, and region. Overtriage, or unnecessary utilization, can lead to additional patient risk and expense. In this study we perform a nationwide descriptive analysis of HEMS for pediatric trauma and assess the incidence of overtriage in this group. We reviewed records from the American College of Surgeons National Trauma Data Bank (2008-11) and included patients less than 16 years of age who were transferred from the scene of injury to a trauma center via HEMS. Overtriage was defined as patients meeting all of the following criteria: Glasgow Coma Scale (GCS) equal to 15, absence of hypotension, an Injury Severity Score (ISS) less than 9, no need for procedure or critical care, and a hospital length of stay of less than 24 hours. A total of 19,725 patients were identified with a mean age of 10.5 years. The majority of injuries were blunt (95.6%) and resulted from motor vehicle crashes (48%) and falls (15%). HEMS transported patients were predominately normotensive (96%), had a GCS of 15 (67%), and presented with minor injuries (ISS<9, 41%). Overall, 28 % of patients stayed in the hospital for less than 24 hours, and the incidence of overtriage was 17%. Helicopter overtriage is prevalent among pediatric trauma patients nationwide. The ideal model to predict need for HEMS must consider clinical outcomes in the context of judicious resource utilization. The development of guidelines for HEMS use in pediatric trauma could potentially limit unnecessary transfers while still identifying children who require trauma center care in a timely fashion. Copyright © 2014. Published by Elsevier Inc.

Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis.

PubMed

Safavi, Arash; Skarsgard, Erik D; Rhee, Peter; Zangbar, Bardiya; Kulvatunyou, Narong; Tang, Andrew; O'Keeffe, Terence; Friese, Randall S; Joseph, Bellal

2016-03-01

Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs. Published by Elsevier Inc.

Critical Care for the Patient With Multiple Trauma.

PubMed

Radomski, Michal; Zettervall, Sara; Schroeder, Mary Elizabeth; Messing, Jonathan; Dunne, James; Sarani, Babak

2016-06-01

Trauma remains the leading cause of death worldwide and the leading cause of death in those less than 44 years old in the United States. Admission to a verified trauma center has been shown to decrease mortality following a major injury. This decrease in mortality has been a direct result of improvements in the initial evaluation and resuscitation from injury as well as continued advances in critical care. As such, it is vital that intensive care practitioners be familiar with various types of injuries and their associated treatment strategies as well as their potential complications in order to minimize the morbidity and mortality frequently seen in this patient population. © The Author(s) 2015.

Does transport time help explain the high trauma mortality rates in rural areas? New and traditional predictors assessed by new and traditional statistical methods

PubMed Central

Røislien, Jo; Lossius, Hans Morten; Kristiansen, Thomas

2015-01-01

Background Trauma is a leading global cause of death. Trauma mortality rates are higher in rural areas, constituting a challenge for quality and equality in trauma care. The aim of the study was to explore population density and transport time to hospital care as possible predictors of geographical differences in mortality rates, and to what extent choice of statistical method might affect the analytical results and accompanying clinical conclusions. Methods Using data from the Norwegian Cause of Death registry, deaths from external causes 1998–2007 were analysed. Norway consists of 434 municipalities, and municipality population density and travel time to hospital care were entered as predictors of municipality mortality rates in univariate and multiple regression models of increasing model complexity. We fitted linear regression models with continuous and categorised predictors, as well as piecewise linear and generalised additive models (GAMs). Models were compared using Akaike's information criterion (AIC). Results Population density was an independent predictor of trauma mortality rates, while the contribution of transport time to hospital care was highly dependent on choice of statistical model. A multiple GAM or piecewise linear model was superior, and similar, in terms of AIC. However, while transport time was statistically significant in multiple models with piecewise linear or categorised predictors, it was not in GAM or standard linear regression. Conclusions Population density is an independent predictor of trauma mortality rates. The added explanatory value of transport time to hospital care is marginal and model-dependent, highlighting the importance of exploring several statistical models when studying complex associations in observational data. PMID:25972600

Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.

PubMed

Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro

2017-06-07

The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.

[Process indicators: tools for monitoring the management of severe trauma cases in Catalonia].

PubMed

Prat, Salvi; Muñoz-Ortiz, Laura; Navarro, Salvador; Koo, Maylin; Jiménez-Fábrega, Xavier; Martínez-Cruz, Olga; Espallargues, Mireia

2016-10-01

Process indicators have been widely used to monitor the way trauma care is provided. We aimed to analyze whether data from a hospital's severe trauma register could facilitate the evaluation of aspects of the initial management of severe injuries. Observational, retrospective population-based study. A working group of experts selected a set of trauma care process indicators relevant to some aspects of initial care, diagnosis, and treatment of severely injured patients. Four of the indicators referred to prehospital care and 5 to hospital care. We calculated the observed and expected compliance rates for all the indicators. A total of 1526 cases (44.4%) were analyzed for 2013; 1908 (55.6%) were analyzed for 2014. We were able to evaluate 3 of the 4 prehospital process indicators: endotracheal intubation in patients with a score of 8 on the Glasgow coma scale (GCS) (84% compliance), venous access established before hospital arrival (83.4%), and placement of a neck collar to immobilize the cervical spine (72.7%). Compliance for the hospital-phase indicators were as follows: performance of a computed tomography scan of the head within 60 minutes in cases with a GCS of 13 (5.3% compliance, craniotomy in candidate patients within 2 hours of diagnosis (65%), diagnostic examination for abdominal injuries within 60 minutes in patients with systolic blood pressure 90 mm Hg (89.3%), and therapeutic laparotomy or angiography within 4 hours of abdominal injury in candidate patients with systolic blood pressure 90 mm Hg (51.7%). Compliance was 69.9% for the last process indicator: surgical treatment of open fractures within 8 hours of an accident. Our findings show that a hospital trauma register provides data about care process indicators that can allow us to monitor the quality of care of severely injured patients.

Communication technology in trauma centers: a national survey.

PubMed

Xiao, Yan; Kim, Young-Ju; Gardner, Sharyn D; Faraj, Samer; MacKenzie, Colin F

2006-01-01

The relationship between information and communication technology (ICT) and trauma work coordination has long been recognized. The purpose of the study was to investigate the type and frequency of use of various ICTs to activate and organize trauma teams in level I/II trauma centers. In a cross-sectional survey, questionnaires were mailed to trauma directors and clinicians in 457 trauma centers in the United States. Responses were received from 254 directors and 767 clinicians. Communication with pre-hospital care providers was conducted predominantly via shortwave radio (67.3%). The primary communication methods used to reach trauma surgeons were manual (56.7%) and computerized group page (36.6%). Computerized group page (53.7%) and regular telephone (49.8%) were cited as the most advantageous devices; e-mail (52.3%) and dry erase whiteboard (52.1%) were selected as the least advantageous. Attending surgeons preferred less overhead paging and more cellular phone communication than did emergency medicine physicians and nurses. Cellular phones have become an important part of hospital-field communication. In high-volume trauma centers, there is a need for more accurate methods of communicating with field personnel and among hospital care providers.

Trauma-Informed Care in the Massachusetts Child Trauma Project.

PubMed

Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

2016-05-01

Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. © The Author(s) 2015.

The effect of resident duty hour restriction on trauma center outcomes in teaching hospitals in the state of Pennsylvania.

PubMed

Helling, Thomas S; Kaswan, Sumesh; Boccardo, Justin; Bost, James E

2010-09-01

Resident duty hour restriction was instituted to improve patient safety, but actual impact on patient care is unclear. We sought to determine the effect of duty hour restriction on trauma outcomes in Level I trauma centers (TCs; surgery residency programs) versus Level II TCs (those with no surgery residency programs) within the state of Pennsylvania, using noninferiority as our hypothesis testing. Outcomes (mortality and length of stay [LOS]) were compared in Level II TCs without surgery residencies (n = 7) with Level I TCs (with surgery residencies; n = 14) PRE80 (2001-2003) and POST80 (2004-2007). The subcategories of critically injured patients, Injury Severity Score (ISS) >15, ISS >25, Trauma and Injury Severity Score (TRISS) ≤ 50, Abbreviated Injury Scale (AIS) head/chest/abdomen score >3, age >65 years, mechanism, and shock, functioned as outcome predictors. There was a decrease in mortality overall PRE80 to POST80 for Level I and II TCs. There was a decrease in mortality in Level I TCs POST80 in ISS >15 (16.5% vs. 14.8%, p = 0.0001), AIS (head) score >3 (20.8% vs. 17.8%, p < 0.0001), age >65 years (12.2% vs. 10.7%, p = 0.0013), and blunt mechanism (5.2% vs. 4.6%, p = 0.0004). LOS was reduced in ISS >15, AIS (head) score >3, age >65 years, and penetrating mechanism in Level I TCs POST80. A similar but more profound decrease was also seen in Level II TCs PRE80 and POST80 (ISS >15, 25; AIS (head) score; shock; blunt mechanism; and TRISS ≤ 50). Testing for inhomogeneity identified less-severely injured patients at Level II TCs POST80 compared with Level I TCs in certain subcategories (ISS >15, 25; AIS (head) score; shock; blunt mechanism; and TRISS ≤ 50) regarding mortality and LOS (TRISS >50%). Decreases in mortality and LOS during the study periods were likely not related to resident work hour restriction but rather to overall improvement in outcomes seen at Level II (no residents) and Level I (residents) TCs. Resident work hour restrictions had no discernible effect on patient care (noninferiority).

Trauma scoring systems and databases.

PubMed

Lecky, F; Woodford, M; Edwards, A; Bouamra, O; Coats, T

2014-08-01

This review considers current trauma scoring systems and databases and their relevance to improving patient care. Single physiological measures such as systolic arterial pressure have limited ability to diagnose severe trauma by reflecting raised intracranial pressure, or significant haemorrhage. The Glasgow coma score has the greatest prognostic value in head-injured and other trauma patients. Trauma triage tools and imaging decision rules-using combinations of physiological cut-off measures with mechanism of injury and other categorical variables-bring both increased sophistication and increased complexity. It is important for clinicians and managers to be aware of the diagnostic properties (over- and under-triage rates) of any triage tool or decision rule used in their trauma system. Trauma registries are able to collate definitive injury descriptors and use survival prediction models to guide trauma system governance, through individual patient review and case-mix-adjusted benchmarking of hospital and network performance with robust outlier identification. Interrupted time series allow observation in the changes in care processes and outcomes at national level, which can feed back into clinical quality-based commissioning of healthcare. Registry data are also a valuable resource for trauma epidemiological and comparative effectiveness research studies. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Trauma Time-Out: Evaluating the Effectiveness of Protocol-Based Information Dissemination in the Traumatically Injured Patient.

PubMed

Nolan, Heather R; Fitzgerald, Michael; Howard, Brett; Jarrard, Joey; Vaughn, Danny

Procedural time-outs are widely accepted safety standards that are protocolized in nearly all hospital systems. The trauma time-out, however, has been largely unstudied in the existing literature and does not have a standard protocol outlined by any of the major trauma surgery organizations. The goal of this study was to evaluate our institution's use of the trauma time-out and assess how trauma team members viewed its effectiveness. A multiple-answer survey was sent to trauma team members at a Level I trauma center. Questions included items directed at background, experience, opinions, and write-in responses. Most responders were experienced trauma team members who regularly participated in trauma codes. All respondents noted the total time required to complete the time-out was less than 5 min, with the majority saying it took less than 1 min. Seventy-five percent agreed that trauma time-outs should continue, with 92% noting that it improved understanding of patient presentation and prehospital evaluation. Seventy-seven percent said it improved understanding of other team member's roles, and 75% stated it improved patient care. Subgroups of physicians and nurses were statistically similar; yet, physicians did note that it improved their understanding of the team member's function more frequently than nurses. The trauma time-out can be an excellent tool to improve patient care and team understanding of the incoming trauma patient. Although used widely at multiple levels of trauma institutions, development of a documented protocol can be the next step in creating a unified safety standard.

The spleen not taken: Differences in management and outcomes of blunt splenic injuries in teenagers cared for by adult and pediatric trauma teams in a single institution.

PubMed

OʼConnor, Sean C; Doud, Andrea N; Sieren, Leah M; Miller, Preston R; Zeller, Kristen A

2017-09-01

Nonoperative management (NOM) of blunt splenic injury, initially touted for the care of pediatric patients, has become the standard of care for stable trauma patients of all ages. In our institution, trauma patients younger than 16 years are managed by the pediatric surgery service and patients 16 years or older are managed by the adult trauma service. Angioembolization is routinely used for adults with blunt splenic injury but rarely used for pediatric patients. A retrospective chart review was performed to determine if more liberal use of angioembolization increases the success rate of NOM of blunt splenic injury in adolescents. Using our institutional trauma registry, we performed a retrospective chart review of 13- to 18-year-olds admitted with blunt splenic injury from 2007 to 2015. One hundred thirty-three patients were identified; 59 were 13- to 15-year-olds and cared for by the Pediatric Trauma service, whereas 74 were 16- to 18-year-olds and cared for by the Adult Trauma service. The cohorts were compared with respect to imaging performed, grade of injury, Injury Severity Score, presence of active extravasation or pseudoaneurysm, interventions performed, blood transfused, intensive care unit days, length of stay, complications, and 30-day mortality rates. There were no significant differences in Injury Severity Score, incidence of active extravasation or pseudoaneurysm identified on computed tomography, or grade of injury between the two cohorts. More patients underwent angioembolization in the "adult" group (p = 0.001) with no difference in the success rate of NOM (p = 0.117). The overall failure rate of NOM of high-grade injuries was only 4.1%. Failure of NOM in high-grade injuries is rare; as a result, the number needed to treat with prophylactic angioembolization would be around 37 patients, resulting in undue risk to many patients with no therapeutic benefit. No improvement in failure rate was seen with aggressive angioembolization, though a larger sample size is needed to rule out type 2 error. Therapeutic, level IV.

Prehospital trauma care: a clinical review.

PubMed

Beuran, M; Paun, S; Gaspar, B; Vartic, N; Hostiuc, S; Chiotoroiu, A; Negoi, I

2012-01-01

There are many controversies related to the trauma patient care during the pre-hospital period nowadays. Due to the heterogeneity of the rescue personnel and variability of protocols used in various countries, the benefit of the prehospital advanced life support on morbidity and mortality has been not established. Systematic review of the literature using computer search of the Library of Medicine and the National Institutes of Health International PubMed Medline database using Entre interface.We reviewed the literature in what concerns the basic and advanced life support given to the trauma patients during the prehospital period. Although the organization of the medical emergency system varies from a country to another, the level of patient'scare can be classified into two main categories: Basic Life Support (BLS) and Advanced Life Support (ALS).There are many studies addressing what to be done at the scene.The prehospital care can be divided into two extremes: stay and play/treat then transfer or scoop and run/load and go. A balance between "scoop and run" and "stay and play" is probably the best approach for trauma patients. The chosen approach should be made according to the mechanism of injury (blunt versus penetrating trauma), distance to the trauma center (urban versus rural) and the available resources. RevistaChirurgia.

Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task.

PubMed

Brüne, Martin; Walden, Sarah; Edel, Marc-Andreas; Dimaggio, Giancarlo

2016-01-01

Borderline personality disorder (BPD) is characterized by a range of interpersonal difficulties, which are, in part, related to adverse experiences during childhood. Unresponsive parenting and traumatization may cause functional impairment of mentalization, i.e. the ability to reflect upon own and others' mental states. However, the relationship of poor parenting, trauma and mentalization in BPD has not exhaustively been studied. Thirty patients diagnosed with BPD and 30 matched control subjects were asked to sequence a novel cartoon-based mentalization task involving complex emotions such as jealousy, shame, guilt etc. In addition, they were required to reason about cognitive and affective mental states of the cartoon characters. The quality of parental care was assessed using a self-report measure for recalled parental rearing style, and childhood trauma was measured in retrospect using the Childhood Trauma Questionnaire. Patients with BPD performed more poorly in all aspects of the cartoon task. Mentalizing skills, particularly relating to affective mental states, were uniquely associated with the quality of recalled parental care and childhood trauma. Together, the quality of parental care and the experience of childhood trauma negatively impact on mentalization in BPD, even in an experimental "offline" task. Copyright © 2015 Elsevier Inc. All rights reserved.

Current status and future options for trauma and emergency surgery in Turkey.

PubMed

Taviloğlu, Korhan; Ertekin, Cemalettin

2008-01-01

The number of trauma victims in Turkey is expected to increase as a consequence of the increasing vehicular traffic, potential for earthquakes, and risk of terrorist attacks. The Turkish Association for Trauma and Emergency Surgery monitors trauma cases, publishes a quarterly journal, organizes trauma courses and seminars for various health personnel nationwide. It is also extending efforts to improve in-hospital care by establishing trauma and emergency surgery fellowships and trauma and emergency surgery centers nationwide, which is run by General Surgeons currently. Turkey faces the same dilemma as the rest of the developed world regarding the future of trauma surgeons in the current era of nonoperative trauma management. We suggest that the field of trauma and emergency surgery be redefined to include emergency general surgery and cavitary trauma.

Developing Self-Care Practices in a Trauma Treatment Course

ERIC Educational Resources Information Center

Shannon, Patricia J.; Simmelink-McCleary, Jennifer; Im, Hyojin; Becher, Emily; Crook-Lyon, Rachel E.

2014-01-01

This article describes the development of self-care practices of social work students who were part of a larger study of students' experiences in a graduate course on the treatment of trauma. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicated that…

Point-of-Care Coagulation Monitoring in Trauma Patients.

PubMed

Stein, Philipp; Kaserer, Alexander; Spahn, Gabriela H; Spahn, Donat R

2017-06-01

Trauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate-based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

In an idealized world: can discrepancies across self-reported parental care and high betrayal trauma during childhood predict infant attachment avoidance in the next generation?

PubMed

Bernstein, Rosemary E; Laurent, Heidemarie K; Musser, Erica D; Measelle, Jeffery R; Ablow, Jennifer C

2013-01-01

Adult caregivers' idealization of their parents as assessed by the Adult Attachment Interview is a risk factor for the intergenerational transmission of the insecure-avoidant attachment style. This study evaluated a briefer screening approach for identifying parental idealization, testing the utility of prenatal maternal self-report measures of recalled betrayal trauma and parental care in childhood to predict observationally assessed infant attachment avoidance with 58 mother-infant dyads 18 months postpartum. In a logistic regression that controlled for maternal demographics, prenatal psychopathology, and postnatal sensitivity, the interaction between women's self-reported childhood high betrayal trauma and the level of care provided to them by their parents was the only significant predictor of 18-month infant security versus avoidance. Results suggest that betrayal trauma and recalled parental care in childhood can provide a means of identifying caregivers whose infant children are at risk for avoidant attachment, potentially providing an efficient means for scientific studies and clinical intervention aimed at preventing the intergenerational transmission of attachment problems.

Impact of the version of the abbreviated injury scale on injury severity characterization and quality assessment of trauma care.

PubMed

Tohira, Hideo; Jacobs, Ian; Matsuoka, Tetsuya; Ishikawa, Kazuo

2011-07-01

The Abbreviated Injury Scale (AIS) was updated in 2008 (AIS 2008). We aimed to investigate the impact of AIS 2008 on the characterization of injury severity and quality assessment of trauma care. We identified all blunt trauma patients in the Japan Trauma Data Bank. First, we converted AIS 98 codes to AIS 2008 codes using a mapping table. Next, we compared Injury Severity Scores (ISSs) and New ISSs (NISSs) based on AIS 98 and AIS 2008. We compared the proportion of major trauma (ISS >15) between the two AISs. We derived risk-adjusted models using the two AISs and separately ranked hospitals according to the observed-to-expected death (OE) ratio. We counted the number of performance outliers for the two rankings. We analyzed the association between the percent change in OE ratios and the proportion of NISS outliers (change in NISS of <-12). There were 19,899 subjects. The ISSs and NISSs based on AIS 2008 were significantly less than those based on AIS 98. The proportion of major trauma was 46.3% and 38.9% for AIS 98 and AIS 2008, respectively (p < 0.001). The numbers of performance outliers were different between the two rankings. There was a significant positive linear relationship between the percent change in the OE ratio and the proportion of NISS outliers. The use of different AIS versions influenced the selection of major trauma patients and affected the quality assessment of the trauma care. Researchers should be aware of these findings when selecting the version of the AIS.

Isolated transient loss of consciousness is an indicator of significant injury.

PubMed

Owings, J T; Wisner, D H; Battistella, F D; Perlstein, J; Walby, W F; Tharratt, R S

1998-09-01

To determine if isolated transient loss of consciousness is an indicator of significant injury. University-based level I trauma center. Phase 1 retrospective case series of all patients with trauma admitted directly from the emergency department to the operating room or an intensive care unit who had transient loss of consciousness as their only trauma triage criterion. Phase 2 prospective case series of all trauma patients transported by emergency medical system personnel with transient loss of consciousness as their only trauma triage criterion. Emergency operation and intensive care unit admission. Phase 1: From January 1, 1992, to March 31, 1995, we admitted 10255 patients with trauma. Three hundred seven (3%) met the enrollment criteria and were admitted to the operating room (n = 168) or intensive care unit (n = 139). Of these, 58 (18.9%) were taken to the operating room emergently to manage life-threatening injuries: 11 (4%) had craniotomies and 47 (15%) had non-neurosurgical operations. Phase 2: From July 1 to December 31, 1996, 2770 trauma patients were transported to our facility; 135 (4.9%) met the enrollment criteria. Forty-one (30.4%) of these required admission, and 6 (4.4%) were taken emergently to the operating room from the emergency department (1 [1%] for a craniotomy, 3 [2.2%] for intra-abdominal bleeding, and 2 [1.5%] for other procedures). Two (1.5%) of the 135 patients died. Patients with isolated transient loss of consciousness are at significant risk of critical surgical and neurosurgical injuries. These patients should be triaged to trauma centers or hospitals with adequate imaging, surgical, and neurosurgical resources.

Cultural Expressions of Intergenerational Trauma and Mental Health Nursing Implications for U.S. Health Care Delivery Following Refugee Resettlement: An Integrative Review of the Literature.

PubMed

Hudson, Christina Camille; Adams, Susie; Lauderdale, Jana

2016-05-01

The purpose of this integrative review of the literature is to examine cultural expressions of intergenerational trauma among refugees following resettlement, and to determine culturally sensitive mental health care practice implications for health care practitioners working in U.S. health care delivery. Data were collected utilizing a comprehensive computer-assisted search in CINAHL and PsychARTICLES/ProQuest from 2003 to 2013 of full text, peer-reviewed, scholarly journal articles, published in English. Eight articles met selection criteria and were analyzed using Gadamer's philosophical interpretation of play, symbolism, and festival in The Relevance of the Beautiful Six recurrent themes were identified important to refugee health care delivery: silence, communication, adaptation, relationship, remembering, and national redress. Practitioners need to consider cultural influences of intergenerational trauma in processing grief related to loss and how artistic modes of expression are experienced, both individually and communally, in refugee health care delivery. © The Author(s) 2015.

An acute care surgery rotation contributes significant general surgical operative volume to residency training compared with other rotations.

PubMed

Stanley, Matthew D; Davenport, Daniel L; Procter, Levi D; Perry, Jacob E; Kearney, Paul A; Bernard, Andrew C

2011-03-01

Surgical resident rotations on trauma services are criticized for little operative experience and heavy workloads. This has resulted in diminished interest in trauma surgery among surgical residents. Acute care surgery (ACS) combines trauma and emergency/elective general surgery, enhancing operative volume and balancing operative and nonoperative effort. We hypothesize that a mature ACS service provides significant operative experience. A retrospective review was performed of ACGME case logs of 14 graduates from a major, academic, Level I trauma center program during a 3-year period. Residency Review Committee index case volumes during the fourth and fifth years of postgraduate training (PGY-4 and PGY-5) ACS rotations were compared with other service rotations: in total and per resident week on service. Ten thousand six hundred fifty-four cases were analyzed for 14 graduates. Mean cases per resident was 432 ± 57 in PGY-4, 330 ± 40 in PGY-5, and 761 ± 67 for both years combined. Mean case volume on ACS for both years was 273 ± 44, which represented 35.8% (273 of 761) of the total experience and exceeded all other services. Residents averaged 8.9 cases per week on the ACS service, which exceeded all other services except private general surgery, gastrointestinal/minimally invasive surgery, and pediatric surgery rotations. Disproportionately more head/neck, small and large intestine, gastric, spleen, laparotomy, and hernia cases occurred on ACS than on other services. Residents gain a large operative experience on ACS. An ACS model is viable in training, provides valuable operative experience, and should not be considered a drain on resident effort. Valuable ACS rotation experiences as a resident may encourage graduates to pursue ACS as a career. Copyright © 2011 by Lippincott Williams & Wilkins

Care related and transit neuronal injuries after cervical spine trauma: state of care and practice in Nigeria.

PubMed

Mezue, Wilfred C; Onyia, Ephraim; Illoabachie, Izuchukwu C; Chikani, Mark C; Ohaegbulam, Samuel C

2013-09-15

Suboptimal care during extraction and transfer after spinal trauma predisposes patients to additional spinal cord injury. This study examines the factors that contribute to care related and transit injuries and suggests steps to improve standard of care in spinal trauma patients in Nigeria. It is a questionnaire-based prospective study of patients admitted with cervical cord injury to two neurosurgical centers in Enugu, Nigeria, between March 2008 and October 2010. Demography, mechanism of injury, mode of extraction from the scene and transportation to first visited hospital, precautions taken during transportation, and treatment received before arriving at the neurosurgical unit were analyzed. There were 53 (77.9%) males, the mean age was 33.9 years, and 23.5% had concomitant head injury. Average delay was 3.5 h between trauma and presentation to initial care and 10.4 days before presentation to definitive care. Only 26.5% presented primarily to tertiary centers with trauma services. About 94.1% were extracted by passersby. None of the patients received cervical spine protection either during extrication or in the course of transportation to initial care, and 35.3% were sitting in a motor vehicle or supported on a motorbike during transport. Of the 43 patients transported lying down, 41.9% were in the back seat of a sedan, and only 11.8% were transported in an ambulance. Neurological dysfunction was first noticed after removal from the scene by 41.2% of patients, while 7.4% noticed it on the way to or during initial care. During subsequent transfer to definitive centers, only 36% had cervical support, although 78% were transported in ambulances. Ignorance of pre-hospital management of cervically injured patients exists in the general population and even among medical personnel and results in preventable injuries. There is need for urgent training, provision of paramedical services, and public enlightenment.

Quality of Care Delivered Before vs After a Quality-Improvement Intervention for Acute Geriatric Trauma.

PubMed

Min, Lillian; Cryer, Henry; Chan, Chiao-Li; Roth, Carol; Tillou, Areti

2015-05-01

Older trauma-injury patients had improved recovery after we implemented routine geriatric consultation for patients aged 65 years and older admitted to the trauma service of a Level I academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown. We conducted a prospective observation comparing medical care after (December 2007 to November 2009) vs before (December 2006 to November 2007) implementation of the geriatric consult-based intervention. To measure quality of care (QOC), we used 33 previously validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 geriatric consult (GC) vs 71 control group patients. As prespecified subgroup analyses, we aggregated QIs by type: geriatric (eg, delirium screening) vs nongeriatric condition-based care (eg, thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and nongeriatric QOC scores for each patient (number of QIs passed/number of QIs eligible), and compared patient-level QOC for the GC vs control group, adjusting for age, sex, ethnicity, comorbidity, and injury severity. Sixty-three percent of the GC patients vs 11% of the control group patients received a geriatric consultation. We evaluated 2,505 QIs overall (1,664 geriatric type and 841 nongeriatric QIs). In general, fewer geriatric-type QIs were passed than nongeriatric QIs (71% vs 81%; p < 0.001). We provided better overall QOC to the GC (77%) than control group patients (73%; p < 0.05). However, the difference was not statistically significant after multivariable adjustment (p = 0.08). We improved geriatric QOC for the GC (74%) compared with the control group (68%; p < 0.01), a difference that was significant after multivariable adjustment (p = 0.01). Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients. Published by Elsevier Inc.

Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis.

PubMed

Raatiniemi, Lasse; Liisanantti, Janne; Niemi, Suvi; Nal, Heini; Ohtonen, Pasi; Antikainen, Harri; Martikainen, Matti; Alahuhta, Seppo

2015-11-05

Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland. We examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred. A total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5% vs. 9.3%, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9% in urban and 13.3% in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95% confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death. The severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients' survival, especially in rural areas.

Measuring trauma center injury prevention activity: an assessment and reporting tool.

PubMed

Sise, Michael J; Sise, Carol Beth

2006-02-01

To develop an assessment and reporting tool for a trauma center's community partnership strategy to deliver injury prevention programs in a large metropolitan area. The tool was designed to track prevention activity and serve as a reporting format for the parent health system, county designating agency, and the American College of Surgeons' Trauma Center Verification Process. The tool collected data including trauma center paid and volunteer personnel time, equipment, resource, and financial costs, community group and public agency contributions, number of community members receiving prevention material or presentations, impact on public policy, and print and broadcast media coverage. These measurements were incorporated in a reporting grid format. Six youth injury prevention programs were evaluated over a recent 2-year interval to demonstrate the tool's usefulness. Of six programs, three focused on motor vehicle injuries, one on teen suicide, one on firearm injuries, and one on drug and alcohol abuse. Trauma Center personnel asset allocation included 3% full-time equivalent by the Trauma Medical Director, 30% by the Injury Prevention and Community Outreach Coordinator, and 473 person hours (both work and volunteer) by physicians, nurses, and other personnel. Trauma Center equipment and fixed asset expenses totaled $3,950 and monetary contribution totaled $4,430. Community groups and public agencies contributed 20,400 person hours with estimated in-kind costs exceeding $750,000. Five of the six programs continued during the 2-year period. A gun-lock giveaway program was suspended because of a product recall. A total of over 29,000 youth received prevention material and presentations. Four public policy initiatives and 18 Trauma Center media stories with over 50 mentions and 37 new community partnerships resulted. The reports generated were easily incorporated in the trauma center's reports to local and national organizations and agencies. This assessment tool provided a detailed but concise accounting of trauma center injury prevention activity. The reports generated were effective in displaying the center's work.

Nine-point plan to improve care of the injured patient: A case study from Kenya.

PubMed

Bachani, Abdulgafoor M; Botchey, Isaac; Paruk, Fatima; Wako, Daniel; Saidi, Hassan; Aliwa, Bethuel; Kibias, Simon; Hyder, Adnan A

2017-12-01

Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care. We aimed to assess the trauma-care system in Kenya and to develop and implement a plan to improve it. A trauma system profile was performed to understand the landscape for the care of the injured patient in Kenya. This process helped identify key gaps in care ranging from prehospital to hospital-based care. In response to this observation, a 9-point plan to improve trauma care in Kenya was developed and implemented in close collaboration with local stakeholders. The 9-point plan was centered on engagement of the stakeholders, generation of key data to guide and improve services, capacity development for prehospital and hospital care, and strengthening policy and legislation. There is an urgent need for coordinated strategies to provide appropriate and timely medical care to injured individuals in low- or middle-income countries to decrease the burden of injuries and related fatalities. Our work in Kenya shows that such an integrated system of trauma care could be achieved through a step-by-step integrated and multifaceted approach that emphasizes engagement of local stakeholders and evidence-based approaches to ensure effectiveness, efficiency, and sustainability of system-wide improvements. This plan and lessons learned in its development and implementation could be adaptable to other similar settings to improve the care of the injured patient in low- or middle-income countries. Copyright © 2017 Elsevier Inc. All rights reserved.

Combat Wound Initiative program.

PubMed

Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

2010-07-01

The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.

Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial.

PubMed

Holmes, James F; Kelley, Kenneth M; Wootton-Gorges, Sandra L; Utter, Garth H; Abramson, Lisa P; Rose, John S; Tancredi, Daniel J; Kuppermann, Nathan

2017-06-13

The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. To determine if the FAST examination during initial evaluation of injured children improves clinical care. A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95% CI, -8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, -0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95% CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95% CI, -$6651 to $4291). Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting. clinicaltrials.gov Identifier: NCT01540318.

Evaluation of a Group-Based Trauma Recovery Program in Gaza: Students' Subjective Experiences

ERIC Educational Resources Information Center

Barron, Ian; Abdullah, Ghassan

2012-01-01

Internationally, evaluation of group-based trauma recovery programs has relied upon normative outcome measures, with no studies systematically analyzing children's subjective experience for program development. In contrast, the current study explored children's experience of a Gazan recovery program "in their own words." Twenty-four…

Self Care for Educators

ERIC Educational Resources Information Center

National Child Traumatic Stress Network, 2008

2008-01-01

Trauma takes a toll on children, families, schools, and communities. Trauma can also take a toll on school professionals. Any educator who works directly with traumatized children and adolescents is vulnerable to the effects of trauma--referred to as "compassion fatigue" or "secondary traumatic stress"--being physically, mentally, or emotionally…

National cost of trauma care by payer status.

PubMed

Velopulos, Catherine G; Enwerem, Ngozi Y; Obirieze, Augustine; Hui, Xuan; Hashmi, Zain G; Scott, Valerie K; Cornwell, Edward E; Schneider, Eric B; Haider, Adil H

2013-09-01

Several studies have described the burden of trauma care, but few have explored the economic burden of trauma inpatient costs from a payer's perspective or highlighted the differences in the average costs per person by payer status. The present study provides a conservative inpatient national trauma cost estimate and describes the variation in average inpatient trauma cost by payer status. A retrospective analysis of patients who had received trauma care at hospitals in the Nationwide Inpatient Sample from 2005-2010 was conducted. Our sample patients were selected using the appropriate "International Classification of Diseases, Ninth Revision, Clinical Modification" codes to identify admissions due to traumatic injury. The data were weighted to provide national population estimates, and all cost and charges were converted to 2010 US dollar equivalents. Generalized linear models were used to describe the costs by payer status, adjusting for patient characteristics, such as age, gender, and race, and hospital characteristics, such as location, teaching status, and patient case mix. A total of 2,542,551 patients were eligible for the present study, with the payer status as follows: 672,960 patients (26.47%) with private insurance, 1,244,817 (48.96%) with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) with other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082 (46.79%), followed by private insurance ($10,772,025,421 [28.72%]), Medicaid ($3,711,686,012 [9.89%], self-pay ($2,831,438,460 [7.55%]), and other payer types ($2,370,187,494 [6.32%]. The estimated yearly trauma inpatient cost burden was $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had a significantly higher mean cost per person than did the Medicare, Medicaid, self-pay, or no charge patients. The results of the present study have demonstrated that the distribution of trauma burden across payers is significantly different from that of the overall healthcare system and suggest that although the burden of trauma is high, the burden of self-pay or nonreimbursed inpatient services is actually lower than that of overall medical care. Copyright © 2013 Elsevier Inc. All rights reserved.

Patient volume per surgeon does not predict survival in adult level I trauma centers.

PubMed

Margulies, D R; Cryer, H G; McArthur, D L; Lee, S S; Bongard, F S; Fleming, A W

2001-04-01

The 1999 American College of Surgeons resources for optimal care document added the requirement that Level I trauma centers admit over 240 patients with Injury Severity Score (ISS) > 15 per year or that trauma surgeons care for at least 35 patients per year. The purpose of this study was to test the hypothesis that high volume of patients with ISS > 15 per individual trauma surgeon is associated with improved outcome. Data were obtained from the trauma registry of the five American College of Surgeons-verified adult Level I trauma centers in our mature trauma system between January 1, 1998, and March 31, 1999. Data abstracted included age, sex, Glasgow Coma Scale (GCS) score, intensive care unit length of stay, hospital length of stay, probability of survival (Ps), mechanism of injury, number of patients per each trauma surgeon and institution, and mortality. Multiple logistic regression was performed to select independent variables for modeling of survival. From the five Level I centers there were 11,932 trauma patients in this time interval; of these, 1,754 patients (14.7%) with ISS > 15 were identified and used for analysis. Patients with ISS > 15 varied from 173 to 625 per institution; trauma surgeons varied from 8 to 25 per institution; per-surgeon patient volume varied from 0.8 to 96 per year. Logistic regression analysis revealed that the best independent predictors of survival were Ps, GCS score, age, mechanism of injury, and institutional volume (p < 0.01). Age and institutional volume correlated negatively with survival. Analysis of per-surgeon patient caseload added no additional predictive value (p = 0.44). The significant independent predictors of survival in severely injured trauma patients are Ps, GCS score, age, mechanism of injury, and institutional volume. We found no statistically meaningful contribution to the prediction of survival on the basis of per-surgeon patient volume. Since this volume criterion for surgeon enpanelment and trauma center designation would not be expected to improve outcome, such a requirement should be justified by other measures or abandoned.

Connecting Refugees to Substance Use Treatment: A Qualitative Study.

PubMed

McCleary, Jennifer S; Shannon, Patricia J; Cook, Tonya L

2016-01-01

An emerging body of literature identifies substance use as a growing concern among refugees resettling in the United States. Like immigrants, refugees may face cultural, linguistic, or systems barriers to connecting with mainstream substance use treatment programs, which may be compounded by refugees' unique experiences with exposure to trauma, displacement in refugee camps, and resettlement. This qualitative study explores factors that support and prevent refugees from connecting with chemical health treatment. Fifteen participants who identified as social service or public health professionals who work with refugees responded to an online, semistructured survey about their experiences referring refugees to substance use treatment. Resulting data was analyzed using thematic analysis. Themes emerged identifying a lack of culturally informed treatment models, policy issues, and client characteristics such as motivation and past trauma as barriers to engaging with treatment. Ongoing case management and coordination were identified as important to successful linkage. Findings from this study contribute to a better understanding of how to support refugees seeking substance use treatment and suggest that developing trauma informed, culturally relevant models of treatment that are integrated with primary health care and geographically accessible may enhance treatment linkage.

Scottish urban versus rural trauma outcome study.

PubMed

McGuffie, A Crawford; Graham, Colin A; Beard, Diana; Henry, Jennifer M; Fitzpatrick, Michael O; Wilkie, Stewart C; Kerr, Gary W; Parke, Timothy R J

2005-09-01

Outcome following trauma and health care access are important components of health care planning. Resources are limited and quality information is required. We set the objective of comparing the outcomes for patients suffering significant trauma in urban and rural environments in Scotland. The study was designed as a 2 year prospective observational study set in the west of Scotland, which has a population of 2.58 million persons. Primary outcome measures were defined as the total number of inpatient days, total number of intensive care unit days, and mortality. The participants were patients suffering moderate (ISS 9-15) and major (ISS>15) trauma within the region. The statistical analysis consisted of chi square test for categorical data and Mann Whitney U test for comparison of medians. There were 3,962 urban (85%) and 674 rural patients (15%). Urban patients were older (50 versus 46 years, p = 0.02), were largely male (62% versus 57%, p = 0.02), and suffered more penetrating traumas (9.9% versus 1.9%, p < 0.001). All prehospital times are significantly longer for rural patients (p < 0.001), include more air ambulance transfers (p < 0.001), and are characterized by greater paramedic presence (p < 0.001). Excluding neurosurgical and spinal injuries transfers, there was a higher proportion of transfers in the rural major trauma group (p = 0.002). There were more serious head injuries in the urban group (p = 0.04), and also a higher proportion of urban patients with head injuries transferred to the regional neurosurgical unit (p = 0.037). There were no differences in length of total inpatient stay (median 8 days, p = 0.7), total length of stay in the intensive care unit (median two days, p = 0.4), or mortality (324 deaths, moderate trauma, p = 0.13; major trauma, p = 0.8). Long prehospital times in the rural environment were not associated with differences in mortality or length of stay in moderately and severely injured patients in the west of Scotland. This may lend support to a policy of rationalization of trauma services in Scotland.

The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service.

PubMed

Laing, G L; Bruce, J L; Aldous, C; Clarke, D L

2014-01-01

The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry. Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured. The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths. The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were identified and new strategies have been planned to overcome these problems and integrate the trauma registry into the process of clinical care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ocular injury: Prevalence in different rural population of Bangladesh.

PubMed

Khan, A K

2013-12-01

This population based cross-sectional study was conducted on 8283 persons of all ages in five districts, selected conveniently, to assess the magnitude of ocular injuries, their causes and consequences in rural Bangladesh. Six Upazilas from five districts and from each Upazila one Union was selected randomly. One village, the ultimate cluster, was then selected conveniently from each Union. All people (n = 8283) in the 8 villages were then surveyed. Out of 8283 population (ranging from 1-120 years) surveyed, 167(2%) had history and/or evidence of past ocular trauma with a yearly incidence of 6.2 per 1000 per year. Study demonstrated a female predominance with male to female ratio being roughly 4:5. Majority (82%) had at least one episode of trauma in their life-time with mean age at 1st trauma being 20 years. Nearly 40% of the traumas were caused by blunt objects followed by penetrating object (22.3%) and sharp instrument (18.1%) with home being the primary place of occurrence (55.1%). Evidence of ocular trauma was found on eye-lid (15%), conjunctiva (11.4%) and cornea (10.2%) as scars. The older participants (≥ 30 years), females, illiterates, agriculture labors, housewives and household workers were more likely to receive trauma. Majority (86.8%) of the subjects received treatment following injury. The median time lapsed between injuries and receiving first treatment was 5 days and that between injury and visiting an eye-specialist was 18 days. Self-treatment and treatment from over-the-counter comprised 45% and 42.1% respectively followed by eye-specialists (25.5%), village quack (22.8%), graduate doctors (19.3%) and traditional healers (6.9%). About 87% received conservative management, with 12.4% needing hospitalization. Most of the injured (92.8%) and non-injured (95.2%) eyes had normal vision before trauma as informed by the respondents. Following trauma, 18% had impaired, 10.7% severely impaired vision and about 6% were blind. Job abstinence due to trauma was 53% with median wage loss being 10 days. The study concludes that point-prevalence of ocular trauma in rural area is around 2% with blunt objects commonly causing the trauma and one in every 16 trauma-hit case undergo blind. Addressing blindness from ocular trauma, should, therefore, be a priority for eye care programs in rural Bangladesh.

Evaluating the traditional day and night shift in an acute care surgery fellowship: Is the swing shift a better choice?

PubMed

Chestovich, Paul J; McNicoll, Christopher F; Ingalls, Nichole K; Kuhls, Deborah A; Fraser, Douglas R; Morrissey, Shawna L; Fildes, John J

2018-01-01

Fellowship trainees in acute care surgery require experience in the management of complex and operative trauma cases. Trauma center staffing usually follows standard 12-hour or 24-hour shifts, with resident and fellow trainees following a similar schedule. Although trauma admissions can be generally unpredictable, we analyzed temporal trends of trauma patient arrival times to determine the best time frame to maximize trainee experience during each day. We reviewed 10 years (2007-2016) of trauma registry data for blunt and penetrating trauma activations. Hourly volumetric trends were observed, and three specific events were chosen for detailed analysis: (1) trauma activation with Injury Severity Score (ISS) greater than 15, (2) laparotomy for trauma, and (3) thoracotomy for trauma. A retrospective shift log was created, which included day (7:00 AM to 7:00 PM), night (7:00 PM to 7:00 AM), and swing (noon to midnight) shifts. A swing shift was chosen because it captures the peak volume for all three events. Means and 95% confidence intervals were calculated, and comparisons were made between shifts using the Wilcoxon matched-pairs signed rank test with Bonferroni correction, and p less than 0.05 considered significant. During the 10-year study period, 28,287 patients were treated at our trauma center. This included the evaluation and management of 7,874 patients with ISS greater than 15, performance of 1,766 laparotomies, and 392 thoracotomies for trauma. Swing shift was superior to both day and night shifts for ISS greater than 15 (p < 0.001). Both swing and night shifts were superior to day shift for laparotomies (p < 0.001). Swing shift was superior to both day shift (p < 0.001) and night shift (p = 0.031). Shifts with the highest yield of ISS greater than 15, laparotomies, and thoracotomies include night and swing shifts on Fridays and Saturdays. Projected experience of acute care surgery fellows in managing complex trauma patients increases with the integration of swing shifts into the schedule. Daily trauma volume follows a temporal pattern which, when used correctly, can increase trainee exposure to complex and operative trauma cases. We encourage other centers to analyze their volume and adjust trainee schedules accordingly to maximize their educational experience. Therapeutic study, level IV.

Geographic distribution of trauma centers and injury-related mortality in the United States.

PubMed

Brown, Joshua B; Rosengart, Matthew R; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2016-01-01

Regionalized trauma care improves outcomes; however, access to care is not uniform across the United States. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. Level I or II trauma centers in the contiguous United States were mapped. State-level age-adjusted injury fatality rates per 100,000 people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNRs) were generated for each state. A NNR less than 1 indicates clustering, while a NNR greater than 1 indicates dispersion. NNRs were tested for difference from random geographic distribution. Fatality rates and NNRs were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. Fatality rates were spatially autocorrelated (Moran's I = 0.35, p < 0.01). Nine states had a clustered pattern (median NNR, 0.55; interquartile range [IQR], 0.48-0.60), 22 had a dispersed pattern (median NNR, 2.00; IQR, 1.68-3.99), and 10 had a random pattern (median NNR, 0.90; IQR, 0.85-1.00) of trauma center distribution. Fatality rate and NNR were correlated (ρ = 0.34, p = 0.03). Clustered states had a lower median injury fatality rate compared with dispersed states (56.9 [IQR, 46.5-58.9] vs. 64.9 [IQR, 52.5-77.1]; p = 0.04). Dispersed compared with clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% vs. 1.2%, p < 0.01). Spatial-lag regression demonstrated that fatality rates increased by 0.02 per 100,000 persons for each unit increase in NNR (p < 0.01). Geographic distribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and require further study to investigate underlying mechanisms. Therapeutic/care management study, level IV.

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa.

PubMed

Boschini, Laura P; Lu-Myers, Yemeng; Msiska, Nelson; Cairns, Bruce; Charles, Anthony G

2016-05-01

Traumatic injuries account for the greatest portion of global surgical burden particularly in low- and middle-income countries (LMICs). To assess effectiveness of a developing trauma system, we hypothesize that there are survival differences between direct and indirect transfer of trauma patients to a tertiary hospital in sub Saharan Africa. Retrospective analysis of 51,361 trauma patients within the Kamuzu Central Hospital (KCH) trauma registry from 2008 to 2012 was performed. Analysis of patient characteristics and logistic regression modelling for in-hospital mortality was performed. The primary study outcome is in hospital mortality in the direct and indirect transfer groups. There were 50,059 trauma patients were included in this study. 6578 patients transferred from referring facilities and 43,481 patients transported from the scene. The indirect and direct transfer cohorts were similar in age and sex. The mechanism of injury for transferred patients was 78.1% blunt, 14.5% penetrating, and 7.4% other, whereas for the scene group it was 70.7% blunt, 24.0% penetrating, and 5.2% other. Median times to presentation were 13 (4-30) and 3 (1-14)h for transferred and scene patients, respectively. Mortality rate was 4.2% and 1.6% for indirect and direct transfer cohorts, respectively. A total of 8816 patients were admitted of which 3636 and 5963 were in the transfer and scene cohort, respectively. After logistic regression analysis, the adjusted in-hospital mortality odds ratio was 2.09 (1.24-3.54); P=0.006 for indirect transfer versus direct transfer cohort, after controlling for significant covariates. Direct transfer of trauma patients from the scene to the tertiary care centre is associated with a survival benefit. Our findings suggest that trauma education and efforts directed at regionalization of trauma care, strengthening pre-hospital care and timely transfer from district hospitals could mitigate trauma-related mortality in a resource-poor setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors.

PubMed

Thompson, Sanna J; Maccio, Elaine M; Desselle, Sherry K; Zittel-Palamara, Kimberly

2007-08-01

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

Compassionate listening - managing psychological trauma in refugees.

PubMed

Gardiner, Joanne; Walker, Kate

2010-04-01

The physical and psychosocial effects of trauma in refugees are wide ranging and long lasting. They can affect symptom presentation, the patient-doctor relationship and management of refugee victims of trauma. This article discusses how refugees survivors of trauma may present to the general practitioner and gives an approach to psychological assessment and management. A strong therapeutic relationship built by patient led, sensitive assessment over time is the foundation to care. A management framework based on trauma recovery stages and adapted for general practice, is presented.

[Models of Mental Health Care for Vulnerable Refugees in the Community].

PubMed

Schellong, Julia; Epple, Franziska; Weidner, Kerstin; Möllering, Andrea

2017-04-01

A non-neglectable portion of people that have fled to Germany have been subjected to expulsion, violence, torture and grave human loss. In some of them, signs of secondary mental problems are obvious. In the light of the efforts at integration, these diseases must not be neglected. Outlined are the federal legal requirements and how the cost coverage, as well as the admission to health care system, is structured. Additionally, 2 exemplary regional models for psychosomatic health care are being introduced: Dresden's "Stepped Care Model for Psychologically Vulnerable Refugees" includes phased offers for prevention and treatment of acute mental crises, as well as somatoform disorders in refugees and their volunteer helpers. The PSZ in Bielefeld unites already existing expertise of social work and trauma therapy to form a shared project and favors, among other things, training courses and the instruction of language mediators. The local circumstances and differences lead to individual, sometimes totally new solutions. Already existing clinical care offers as well as concepts of trauma therapy are focal points for the development of a comprehensive health care provision. Most effective is a combination of medicinal care, psychosocial networking and psychosomatic treatment. For a working health care provision without parallel structures it is indispensible to use expertise in trauma therapy that is already in place. While being very resource-saving psychosomatic centers offer targeted applications in the network of all actors in refugee care especially when combined with well-trained volunteers and language mediators, informed on the issue of trauma. © Georg Thieme Verlag KG Stuttgart · New York.

Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

PubMed

Khansa, Ibrahim; Khansa, Lara; Pearson, Gregory D

2016-02-01

Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p < 0.001) and the proportion of patients on Medicaid increased (7.8 percent to 25.4 percent; p < 0.001). Overall surgeon reimbursement rate increased from 14.3 percent to 19.8 percent (p < 0.001). After implementation of the Affordable Care Act, we observed a significant reduction in the proportion of maxillofacial trauma patients who were uninsured. Surgeons' overall reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy

PubMed Central

Kirkpatrick, Andrew W.; Ball‡, Chad G.; D'Amours, Scott K.; Zygun, David

2008-01-01

Traumatic injury remains the leading cause of potentially preventable death in Canadians under age 40 years. Although only a minority of patients present with hemodynamic instability, these patients have a significant chance of dying. The causes of instability must be recognized and corrected quickly by using a systematic approach. To allow key supportive interventions to be undertaken swiftly, it is more important to identify and prioritize systemic compromise than to confirm specific diagnoses. Most potentially preventable trauma death relates to airway obstruction, hemopneumothorax, intracranial hemorrhage and intracavitary bleeding. Definitive airway control should be assured as a first priority. Hemopneumothoraces are typically addressed by chest tube insertion, although thoracic exploration will occasionally be urgently required. Hemorrhage control is much more important than fluid resuscitation and mandates the earliest possible definitive management. Unstable patients nearing physiological exhaustion require abbreviated or “damage-control” surgical tactics. This should be recognized early in the resuscitation rather than late in an operative procedure. The management of expanding intracranial hemorrhage requires optimization of oxygenation, ventilation and circulatory support while urgent CT and expert neurosurgical care are provided. Polytrauma presenting with head injury challenges the most developed of trauma systems, necessitating thoughtful prioritization of care and taking into consideration local capabilities. Bedside trauma sonography is an evolving tool that complements the physical examination during an initial survey. Future breakthroughs in trauma resuscitation may involve procoagulant medications, imaging technology, circulatory assist techniques and the use of inflammatory modulators. The greatest future challenge in trauma care, though, will be the provision of basic organized resuscitative care to the global community. PMID:18248707

Unconscious race and class bias: its association with decision making by trauma and acute care surgeons.

PubMed

Haider, Adil H; Schneider, Eric B; Sriram, N; Dossick, Deborah S; Scott, Valerie K; Swoboda, Sandra M; Losonczy, Lia; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Freischlag, Julie A; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A

2014-09-01

Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making. A prospective Web-based survey was administered to active members of the Eastern Association for the Surgery of Trauma. Participants completed nine clinical vignettes, each with three trauma/acute care surgery management questions. Race Implicit Association Test (IAT) and social class IAT assessments were completed by each participant. Multivariable, ordered logistic regression analysis was then used to determine whether implicit biases reflected on the IAT tests were associated with vignette responses. In total, 248 members of the Eastern Association for the Surgery of Trauma participated. Of these, 79% explicitly stated that they had no race preferences and 55% stated they had no social class preferences. However, 73.5% of the participants had IAT scores demonstrating an unconscious preference toward white persons; 90.7% demonstrated an implicit preference toward upper social class persons. Only 2 of 27 vignette-based clinical decisions were associated with patient race or social class on univariate analyses. Multivariable analyses revealed no relationship between IAT scores and vignette-based clinical assessments. Unconscious preferences for white and upper-class persons are prevalent among trauma and acute care surgeons. In this study, these biases were not statistically significantly associated with clinical decision making. Further study of the factors that may prevent implicit biases from influencing patient management is warranted. Epidemiologic study, level II.

Access to specialist care: Optimizing the geographic configuration of trauma systems

PubMed Central

Jansen, Jan O.; Morrison, Jonathan J.; Wang, Handing; He, Shan; Lawrenson, Robin; Hutchison, James D.; Campbell, Marion K.

2015-01-01

BACKGROUND The optimal geographic configuration of health care systems is key to maximizing accessibility while promoting the efficient use of resources. This article reports the use of a novel approach to inform the optimal configuration of a national trauma system. METHODS This is a prospective cohort study of all trauma patients, 15 years and older, attended to by the Scottish Ambulance Service, between July 1, 2013, and June 30, 2014. Patients underwent notional triage to one of three levels of care (major trauma center [MTC], trauma unit, or local emergency hospital). We used geographic information systems software to calculate access times, by road and air, from all incident locations to all candidate hospitals. We then modeled the performance of all mathematically possible network configurations and used multiobjective optimization to determine geospatially optimized configurations. RESULTS A total of 80,391 casualties were included. A network with only high- or moderate-volume MTCs (admitting at least 650 or 400 severely injured patients per year, respectively) would be optimally configured with a single MTC. A network accepting lower-volume MTCs (at least 240 severely injured patients per year) would be optimally configured with two MTCs. Both configurations would necessitate an increase in the number of helicopter retrievals. CONCLUSION This study has shown that a novel combination of notional triage, network analysis, and mathematical optimization can be used to inform the planning of a national clinical network. Scotland’s trauma system could be optimized with one or two MTCs. LEVEL OF EVIDENCE Care management study, level IV. PMID:26335775

Hospital mortality following trauma: an analysis of a hospital-based injury surveillance registry in sub-Saharan Africa.

PubMed

Tyson, Anna F; Varela, Carlos; Cairns, Bruce A; Charles, Anthony G

2015-01-01

Injuries are a significant cause of death and disability, particularly in low- and middle-income countries. Health care systems in resource-poor countries lack personnel and are ill equipped to treat severely injured patients; therefore, many injury-related deaths occur after hospital admission. This study evaluates the mortality for hospitalized trauma patients at a tertiary care hospital in Malawi. This study is a retrospective analysis of prospectively collected trauma surveillance data. We performed univariate and bivariate analyses to describe the population and logistic regression analysis to identify predictors of mortality. Tertiary care hospital in sub-Saharan Africa. Patients with traumatic injuries admitted to Kamuzu Central Hospital between January 2010 and December 2012. Predictors of in-hospital mortality. The study population consisted of 7559 patients, with an average age of 27 years (±18 years) and a male predominance of 76%. Road traffic injuries, falls, and assaults were the most common causes of injury. The overall mortality was 4.2%. After adjusting for age, sex, type and mechanism of injury, and shock index, head/spine injuries had the highest odds of mortality, with an odds ratio of 5.80 (2.71-12.40). The burden of injuries in sub-Saharan Africa remains high. At this institution, road traffic injuries are the leading cause of injury and injury-related death. The most significant predictor of in-hospital mortality is the presence of head or spinal injury. These findings may be mitigated by a comprehensive injury-prevention effort targeting drivers and other road users and by increased attention and resources dedicated to the treatment of patients with head and/or spine injuries in the hospital setting. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.

PubMed

Narayan, Mayur; Tesoriero, Ronald; Bruns, Brandon R; Klyushnenkova, Elena N; Chen, Hegang; Diaz, Jose J

2015-04-01

Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR_SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age. There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR_SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR_SOI. For moderate APR_SOI, mortality was significantly lower for TCs compared with NTCs (p < 0.001). Among TCs, the effect was strongest for Level I TC (odds ratio = 0.34). For extreme APR_SOI, mortality was higher at TCs vs NTCs (p < 0.001). Emergency general surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Reshaping Child Welfare's Response to Trauma: Assessment, Evidence-Based Intervention, and New Research Perspectives

ERIC Educational Resources Information Center

Ai, Amy L.; Jackson Foster, Lovie J.; Pecora, Peter J.; Delaney, Nancy; Rodriguez, Wenceslao

2013-01-01

Growing evidence has linked early trauma with severe psychiatric consequences. Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health condition found among some youth in foster care and foster care alumni. However, the current child welfare practice response has not met the demands in both assessment and intervention.…

Abusive Head Trauma at a Tertiary Care Children's Hospital in Mexico City. A Preliminary Study

ERIC Educational Resources Information Center

Diaz-Olavarrieta, Claudia; Garcia-Pina, Corina A.; Loredo-Abdala, Arturo; Paz, Francisco; Garcia, Sandra G.; Schilmann, Astrid

2011-01-01

Objectives: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. Methods: This is a cross-sectional descriptive study of infants and children under 5,…

A population-based study of the association of medical manpower with county trauma death rates in the United States.

PubMed Central

Rutledge, R; Fakhry, S M; Baker, C C; Weaver, N; Ramenofsky, M; Sheldon, G F; Meyer, A A

1994-01-01

OBJECTIVE: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. SUMMARY BACKGROUND DATA: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. METHODS: Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. RESULTS: Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. CONCLUSIONS: This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS) Images Figure 1. PMID:8185404

Implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team.

PubMed

Moloney, Bill; Cameron, Ian; Baker, Ashley; Feeney, Johanna; Korner, Anthony; Kornhaber, Rachel; Cleary, Michelle; McLean, Loyola

2018-04-12

In this paper, we demonstrate the value of implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team by providing brief intensive treatment (comprising risk interventions, brief counselling, collaborative formulation and pharmacological treatment). The team utilised the Conversational Model (CM), a psychotherapeutic approach for complex trauma. Key features of the CM are described in this paper using a clinical case study. The addition of the Conversational Model approach to practice has enabled better understandings of consumers' capacities and ways to then engage, converse, and intervene. The implementation of this intervention has led to a greater sense of self-efficacy amongst clinicians, who can now articulate a clear counselling model of care.

Traumatic Injury in the United States: In-Patient Epidemiology 2000–2011

PubMed Central

DiMaggio, Charles; Ayoung-Chee, Patricia; Shinseki, Matthew; Wilson, Chad; Marshall, Gary; Lee, David C.; Wall, Stephen; Maulana, Shale; Pachter, H. Leon; Frangos, Spiros

2017-01-01

Background Trauma is a leading cause of death and disability in the United States (US). This analysis describes trends and annual changes in in-hospital trauma morbidity and mortality; evaluates changes in age and gender specific outcomes, diagnoses, causes of injury, injury severity and surgical procedures performed; examines the role of teaching hospitals and Level 1 trauma centers in the care of severely injured patients. Methods We conducted a retrospective descriptive and analytic epidemiologic study of an inpatient database representing 20,659,684 traumatic injury discharges from US hospitals between 2000 and 2011. The main outcomes and measures were survey-adjusted counts, proportions, means, standard errors, and 95% confidence intervals. We plotted time series of yearly data with overlying loess smoothing, created tables of proportions of common injuries and surgical procedures, and conducted survey-adjusted logistic regression analysis for the effect of year on the odds of in-hospital death with control variables for age, gender, weekday vs. weekend admission, trauma-center status, teaching-hospital status, injury severity and Charlson index score. Results The mean age of a person discharged from a US hospital with a trauma diagnosis increased from 54.08 (s.e.= 0.71) in 2000 to 59.58 (s.e. = 0.79) in 2011. Persons age 45 to 64 were the only age group to experience increasing rates of hospital discharges for trauma. The proportion of trauma discharges with a Charlson Comorbidity Index score greater than or equal to 3 nearly tripled from 0.048 (s.e. = 0.0015) of all traumatic injury discharges in 2000 to 0.139 (s.e. = 0.005) in 2011. The proportion of patients with traumatic injury classified as severe increased from 22% of all trauma discharges in 2000 (95% CI 21, 24) to 28% in 2011 (95% CI 26, 30). Level 1 trauma centers accounted for approximately 3.3% of hospitals. The proportion of severely injured trauma discharges from Level 1 trauma centers was 39.4% (95% CI 36.8, 42.1). Falls, followed by motor-vehicle crashes, were the most common causes of all injuries. The total cost of trauma-related inpatient care between 2001 and 2011 in the US was $240.7 billion (95% CI 231.0, 250.5). Annual total US inpatient trauma-related hospital costs increased each year between 2001 and 2011, more than doubling from $12.0 billion (95% CI 10.5, 13.4) in 2001 to 29.1 billion (95% CI 25.2, 32.9) in 2011. Conclusions Trauma, which has traditionally been viewed as a predicament of the young, is increasingly a disease of the old. The strain of managing the progressively complex and costly care associated with this shift rests with a small number of trauma centers. Optimal care of injured patients requires a reappraisal of the resources required to effectively provide it given a mounting burden. PMID:27157986

Health Care Issues for Children and Adolescents in Foster Care and Kinship Care.

PubMed

2015-10-01

Children and adolescents who enter foster care often do so with complicated and serious medical, mental health, developmental, oral health, and psychosocial problems rooted in their history of childhood trauma. Ideally, health care for this population is provided in a pediatric medical home by physicians who are familiar with the sequelae of childhood trauma and adversity. As youth with special health care needs, children and adolescents in foster care require more frequent monitoring of their health status, and pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services, health care coordination, and advocacy on their behalves. Copyright © 2015 by the American Academy of Pediatrics.

Helping the employee victim of violence in hospitals.

PubMed

Engel, F; Marsh, S

1986-02-01

Violent behavior of patients is an occupational health hazard of health care professionals that the authors believe has not been fully recognized. Hospitals have developed a wide variety of techniques to manage patients who assault staff but have consistently ignored the plight of the victimized employee. Although professional staff who have been assaulted resist seeing themselves as victims, the authors believe they experience the feelings and reactions typical of other victims and therefore may need help in dealing with emotional trauma. The authors describe a victims' assistance program adopted by Royal Victoria Hospital in Montreal and discuss problems associated with implementing programs like it.

Trauma and posttraumatic stress disorder in a rural primary care population in South Africa.

PubMed

Peltzer, K; Seakamela, M J; Manganye, L; Mamiane, K G; Motsei, M S; Mathebula, T T M

2007-06-01

The aim of this study was to assess trauma events experienced and PTSD among 250 consecutive rural primary clinic patients (all Black Africans, 24% male and 76% female; M age 31.1 yr., SD = 11.8; range 18-65 years) in South Africa using the Trauma History Questionnaire and the PTSD Checklist-Civilian Version, interview administered. Results indicated that the mean number of traumatic events reported was 3.5 (SD = 2.9, range = 0-19) and was significantly higher among men (M= 4.9, SD = 3.5) than women (M = 3.0, SD = 2.6). Among the most frequently endorsed traumas among men were seeing someone seriously injured or killed (60%), serious accident (43.3%), and seeing dead bodies (43.3%), and among women natural disaster (mostly floods) (51.6%), news of a serious injury, life-threatening illness or unexpected death of someone close (31.1%), and seeing someone seriously injured or killed (30%). A current diagnosis of PTSD was found in 12.4% of the sample. Trauma incidence figures were high (M = 3.5) and were comparable with an urban Xhosa primary care population in South Africa (M = 3.8). A current indicative diagnosis of PTSD of 12.4% also compares with other studies; 19.9% among urban Xhosa primary care patients and 11.8% among American primary care patients.

Operating room efficiency: benefits of an orthopaedic traumatologist at a level II trauma center.

PubMed

Althausen, Peter L; Kauk, Justin R; Shannon, Steven; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2014-05-01

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P < 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). This study demonstrates that in our community-based trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Operating Room Efficiency: Benefits of an Orthopaedic Traumatologist at a Level II Trauma Center.

PubMed

Althausen, Peter L; Kauk, Justin R; Shannon, Steven; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2016-12-01

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). This study demonstrates that in our communitybased trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Medication reconciliation in a rural trauma population.

PubMed

Miller, S Lee; Miller, Stephanie; Balon, Jennifer; Helling, Thomas S

2008-11-01

Medication errors during hospitalization can lead to adverse drug events. Because of preoccupation by health care providers with life-threatening injuries, trauma patients may be particularly prone to medication errors. Medication reconciliation on admission can result in decreased medication errors and adverse drug events in this patient population. The purpose of this study is to determine the accuracy of medication histories obtained on trauma patients by initial health care providers compared to a medication reconciliation process by a designated clinical pharmacist after the patient's admission and secondarily to determine whether trauma-associated factors affected medication accuracy. This was a prospective enrollment study during 13 months in which trauma patients admitted to a Level I trauma center were enrolled in a stepwise medication reconciliation process by the clinical pharmacist. The setting was a rural Level I trauma center. Patients admitted to the trauma service were studied. The intervention was medication reconciliation by a clinical pharmacist. The main outcome measure was accuracy of medication history by initial trauma health care providers compared to a medication reconciliation process by a clinical pharmacist who compared all sources, including telephone calls to pharmacies. Patients taking no medications (whether correctly identified as such or not) were not analyzed in these results. Variables examined included admission medication list accuracy, age, trauma team activation mode, Injury Severity Score, and Glasgow Coma Scale (GCS) score. Two hundred thirty-four patients were enrolled. Eighty-four of 234 patients (36%) had an Injury Severity Score greater than 15. Medications were reconciled within an average of 3 days of admission (range 1 to 8) by the clinical pharmacist. Overall, medications as reconciled by the clinical pharmacist were recorded correctly for 15% of patients. Admission trauma team medication lists were inaccurate in 224 of 234 cases (96%). Admitting nurses' lists were more accurate than the trauma team's (11% versus 4%; 95% confidence interval 2.5% to 11.2%). Errors were found by the clinical pharmacist in medication name, strength, route, and frequency. No patients (0/20) with admission GCS less than 13 had accurate medication lists. Seventy of 84 patients (83%) with an Injury Severity Score greater than 15 had inaccurate medication lists. Ten of 234 patients (4%) were ordered wrong medications, and 1 adverse drug event (hypoglycemia) occurred. The median duration of the reconciliation process was 2 days. Only 12% of cases were completed in 1 day, and almost 25% required 3 or more (maximum 8) days. This study showed that medication history recorded on admission was inaccurate. This patient population overall was susceptible to medication inaccuracies from multiple sources, even with duplication of medication histories by initial health care providers. Medication reconciliation for trauma patients by a clinical pharmacist may improve safety and prevent adverse drug events but did not occur quickly in this setting.

Virtual reality, robotics, and other wizardry in 21st century trauma care.

PubMed

Maniscalco-Theberge, M E; Elliott, D C

1999-12-01

The former Special Assistant to the Director on Biomedical Technology, Defense Advanced Research Projects Agency (DARPA), COL RM Satava, notes "Predicting the future trends in any profession jeopardizes the credibility of the author." Thus, we have attempted to outline current systems and prototype models in testing phases. Technologic advances will enable enhanced care of trauma patients. In the acute care setting, they also will affect the educational system in theory and practice.

Association of child maltreatment and psychiatric diagnosis in Brazilian children and adolescents

PubMed Central

Scomparini, Luciana Burim; dos Santos, Bernardo; Rosenheck, Robert Alan; Scivoletto, Sandra

2013-01-01

OBJECTIVES: The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program. METHODS: In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse. RESULTS: The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation. CONCLUSION: All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse. PMID:24037004

Grey’s Anatomy effect: television portrayal of patients with trauma may cultivate unrealistic patient and family expectations after injury

PubMed Central

Serrone, Rosemarie O; Weinberg, Jordan A; Goslar, Pamela W; Wilkinson, Erin P; Thompson, Terrell M; Dameworth, Jonathan L; Dempsey, Shawna R; Petersen, Scott R

2018-01-01

Background Expectations of the healthcare experience may be influenced by television dramas set in the hospital workplace. It is our perception that the fictional television portrayal of hospitalization after injury in such dramas is misrepresentative. The purpose of this study was to compare trauma outcomes on television dramas versus reality. Methods We screened 269 episodes of Grey’s Anatomy, a popular medical drama. A television (TV) registry was constructed by collecting data for each fictional trauma portrayed in the television series. Comparison data for a genuine patient cohort were obtained from the 2012 National Trauma Databank (NTDB) National Program Sample. Results 290 patients composed of the TV registry versus 4812 patients from NTDB. Mortality was higher on TV (22% vs 7%, P<0.0001). Most TV patients went straight from emergency department (ED) to operating room (OR) (71% vs 25%, P<0.0001). Among TV survivors, a relative minority were transferred to long-term care (6% vs 22%, P<0.0001). For severely injured (Injury Severity Score ≥25) survivors, hospital length of stay was less than 1 week for 50% of TV patients versus 20% in NTDB (P<0.0001). Conclusions Trauma patients as depicted on television dramas typically go from ED to OR, and survivors usually return home. Television portrayal of rapid functional recovery after major injury may cultivate false expectations among patients and their families. Level of evidence Level III. PMID:29766127

Holistic ultrasound in trauma: An update.

PubMed

Saranteas, Theodosios; Mavrogenis, Andreas F

2016-10-01

Holistic ultrasound is a total body examination using an ultrasound device aiming to achieve immediate patient care and decision making. In the setting of trauma, it is one of the most fundamental components of care of the injured patients. Ground-breaking imaging software allows physicians to examine various organs thoroughly, recognize imaging signs early, and potentially foresee the onset or the possible outcome of certain types of injuries. Holistic ultrasound can be performed on a routine basis at the bedside of the patients, at admission and during the perioperative period. Trauma care physicians should be aware of the diagnostic and guidance benefits of ultrasound and should receive appropriate training for the optimal management of their patients. In this paper, the findings of holistic ultrasound in trauma patients are presented, with emphasis on the lungs, heart, cerebral circulation, abdomen, and airway. Additionally, the benefits of ultrasound imaging in interventional anaesthesia techniques such as ultrasound-guided peripheral nerve blocks and central vein catheterization are described. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trauma informed care: a radical shift or basic good practice?

PubMed

Isobel, Sophie

2016-12-01

There is significant multidisciplinary work contributing to the implementation of trauma informed care (TIC) into mental health policy and practice in Australia. Within psychiatry, there may be potential confusion about how to navigate the integration of TIC into a speciality built upon treating psychological distress; creating dismissive reactions of a patronising approach and paradoxical radicalism. This paper aims to discuss the need for psychiatry to view TIC as a significant and urgent paradigm shift required to integrate existing knowledge about the prevalence and effects of trauma into a progressive articulation of the relational and interpersonal underpinnings of modern psychiatric practice; and to lead and support its widespread implementation. Active consideration of the intent of TIC may aid in reducing misunderstanding and misaligned resistance while allowing services and individuals an important opportunity to reflect on how to deliver mental health treatment that is universally sensitive to the dynamics of trauma in the care environment. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Trauma system in Greece: Quo Vadis?

PubMed

Anagnostou, Evangelos; Larentzakis, Andreas; Vassiliu, Pantelis

2018-05-23

Implementation of trauma systems has markedly assisted in improving outcomes of the injured patient. However, differences exist internationally as diverse social factors, economic conditions and national particularities are placing obstacles. The purpose of this paper is to critically evaluate the current Greek trauma system, provide a comprehensive review and suggest key actions. An exhaustive search of the - scarce on this subject - English and Greek literature was carried out to analyze all the main components of the Greek trauma system, according to American College of Surgeons' criteria, as well as the WHO Trauma Systems Maturity Index. Regarding prevention, efforts are in the right direction lowering the road traffic incidents-related death rate, however rural and insular regions remain behind. Hellenic Emergency Medical Service (EKAB) has well-defined communications and emergency phone line but faces problems with educating people on how to use it properly. In addition, equal and systematic training of ambulance personnel is a challenge, with the lack of pre-hospital registry and EMS quality assessment posing a question on where the related services are currently standing. Redistribution of facilities' roles with the establishment of the first formal trauma centre in the existing infrastructure would facilitate the development of a national registry and introduction of the trauma surgeon subspecialty with proper training potential. Definite rehabilitation institutional protocols that include both inpatient and outpatient care are needed. Disaster preparedness entails an extensive national plan and regular drills, mainly at the pre-hospital level. The lack, however, of any accompanying quality assurance programs hampers the effort to yield the desirable results. Despite recent economic crisis in Greece, actions solving logistics and organising issues may offer a well-defined, integrated trauma system without uncontrollably raising the costs. Political will is needed for reforms that use pre-existing infrastructure and working power in a more efficient way, with a first line priority being the establishment of the first major trauma centre that could function as the cornerstone for the building of the Greek trauma system. Copyright © 2018 Elsevier Ltd. All rights reserved.