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  1. Article ; Online: GIFTS: Geriatric Intensive Functional Therapy Sessions - For the older trauma patient.

    Wintz, Diane / Schaffer, Kathryn B / Hites, Jennifer J / Wybourn, Christopher / Bui, Eric H / Langness, Simone / Hamel, Michelle / Wright, Kelly / Frey, John R

    The journal of trauma and acute care surgery

    2023  

    Abstract: Background: Considering resources for comprehensive geriatric (GERI) care, it would be beneficial for geriatric trauma (GTP) and medical patients to be co-managed in one program focusing on ancillary therapeutics (AT): physical (PT), occupational (OT), ... ...

    Abstract Background: Considering resources for comprehensive geriatric (GERI) care, it would be beneficial for geriatric trauma (GTP) and medical patients to be co-managed in one program focusing on ancillary therapeutics (AT): physical (PT), occupational (OT), speech (SLP), respiratory (RT) and sleep wake hygiene (SWH). This pilot describes outcomes of GTP in a hospital-wide program focused on GERI-specific AT.
    Methods: GTP and GERI patients were screened by program coordinator (PC) for enrollment at one Level II trauma center from Aug 2021-Dec 2022. Enrolled patients (EP) were admitted to trauma or medicine floors and received repetitive AT with attention to SWH throughout hospitalization and compared to similar non-enrolled patients (NEP). Excluded patients had any of the following: indication of geriatric syndrome with FRAIL 5, no frailty with FRAIL 0, comfort focused plans, or arrived from skilled care. Retrospective chart review of demographics and outcomes was completed for both EP and NEP.
    Results: 224 EP (28 trauma (TR)) were compared to 574 NEP (148 TR). EP showed shorter LOS (mean 3.8 vs 6.1, p = 0.0001), less delirium (3.1% vs 9.6%, p = 0.00222), less time to ambulate (13 h vs 39 h, p = 0.0005), and higher likelihood to discharge home (56% vs 27%, p < 0.0001) as compared to NEP. Median FRAIL was 3 for both groups. Medical enrolled (M-EP) ambulated the soonest at 11 average hours, compared to 23 hours for TR-EP, compared to 39 hours for NEP. Zero delirium events among TR-EP; 25% among TR-NEP, p = 0.00288.
    Conclusion: Despite a small trauma cohort, results support feasibility to include GTP in hospital-wide programs with GERI specific AT. Mobility and cognitive strategies may improve opportunities to avoid delirium, decrease LOS and influence more frequent disposition to home.
    Type of study: Original observational retrospective review.
    Level of evidence: Level IV- Therapeutic / Care Management.
    Language English
    Publishing date 2023-12-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004224
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  2. Article ; Online: Improving length of stay on a trauma service.

    Biffl, Walter L / Lu, Ning / Schultz, Peter R / Wang, Jiayan / Castelo, Matthew R / Schaffer, Kathryn B

    Trauma surgery & acute care open

    2021  Volume 6, Issue 1, Page(s) e000744

    Abstract: Background: Reducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized ...

    Abstract Background: Reducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS.
    Methods: Retrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ
    Results: 1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients.
    Conclusions: Improved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement.
    Level of evidence: III.
    Study type: Therapeutic/Care management.
    Language English
    Publishing date 2021-08-26
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2021-000744
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  3. Article ; Online: Modified Brain Injury Guidelines for preinjury anticoagulation in traumatic brain injury: An opportunity to reduce health care resource utilization.

    Gallagher, Shea P / Capacio, Benedict A / Rooney, Alexandra S / Schaffer, Kathryn B / Calvo, Richard Y / Sise, C Beth / Krzyzaniak, Andrea / Sise, Michael J / Bansal, Vishal / Biffl, Walter L / Martin, Matthew J

    The journal of trauma and acute care surgery

    2023  Volume 96, Issue 2, Page(s) 240–246

    Abstract: Introduction: The Brain Injury Guidelines (BIG) stratify patients by traumatic brain injury (TBI) severity to provide management recommendations to reduce health care resource burden but mandates that patients on anticoagulation (AC) are allocated to ... ...

    Abstract Introduction: The Brain Injury Guidelines (BIG) stratify patients by traumatic brain injury (TBI) severity to provide management recommendations to reduce health care resource burden but mandates that patients on anticoagulation (AC) are allocated to the most severe tertile (BIG 3). We sought to analyze TBI patients on AC therapy using a modified BIG model to determine if this population can offer further opportunity for safe reductions in health care resource utilization.
    Methods: Patients 55 years or older on AC with traumatic intracranial hemorrhage (ICH) from two centers were retrospectively stratified into BIG 1 to 3 risk groups using modified BIG criteria excluding AC as a criterion. Intracranial hemorrhage progression, neurosurgical intervention (NSI), death, and worsened discharge status were compared.
    Results: A total of 221 patients were included, with 23%, 29%, and 48% classified as BIG 1, BIG 2, and BIG 3, respectively. The BIG 3 cohort had a higher rate of AC reversal agents administered (66%) compared with the BIG 1 (40%) and BIG 2 (54%) cohorts ( p < 0.01), as well as ICH progression discovered on repeat head computed tomography (56% vs. 38% vs. 26%, respectively; p < 0.001). No patients in the BIG 1 and 2 cohorts required NSI. No patients in BIG 1 and 3% of patients in BIG 2 died secondary to the ICH. In the BIG 3 cohort, 16% of patients required NSI and 26% died. Brain Injury Guidelines 3 patients had 15 times the odds of mortality compared with BIG 1 patients ( p < 0.01).
    Conclusion: The AC population had higher rates of ICH progression than the BIG literature, but this did not lead to more NSI or mortality in the lower tertiles of our modified BIG protocol. If the modified BIG used the original tertile management on our population, then NS consultation may have been reduced by up to 52%. These modified criteria may be a safe opportunity for further health care resource and cost savings in the TBI population.
    Level of evidence: Prognostic and Epidemiological; Level IV.
    MeSH term(s) Humans ; Retrospective Studies ; Trauma Centers ; Injury Severity Score ; Brain Injuries/therapy ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/therapy ; Intracranial Hemorrhages/etiology ; Patient Acceptance of Health Care ; Glasgow Coma Scale ; Anticoagulants/therapeutic use
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2023-10-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004171
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    ab Jg. 2022: Lesesaal (EG)

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  4. Article: Self-inflicted injury and the older trauma patient: a 20 year review of suicide attempts and outcomes.

    Schaffer, Kathryn B / Dandan, Tala / Bayat, Dunya / Castelo, Matthew R / Reames, Summer H / Hutkin-Slade, Linda / Biffl, Walter L

    European geriatric medicine

    2021  Volume 13, Issue 1, Page(s) 119–125

    Abstract: Purpose: Older patients (Older) have complex health management needs often requiring additional resources. Mental health disorders are common among trauma patients, yet minimal information on older suicidal related injury and outcomes exists. A review ... ...

    Abstract Purpose: Older patients (Older) have complex health management needs often requiring additional resources. Mental health disorders are common among trauma patients, yet minimal information on older suicidal related injury and outcomes exists. A review of trauma patients with intentional self-inflicted injury at one trauma center was done to describe and identify unique elements of this cohort of patients.
    Methods: Trauma registry data from 2000 to 2019 were reviewed for intentional injury and data abstracted included demographics, injury severity, diagnoses, comorbidities and outcomes. Cohorts by age were compared: Older (65 +) vs Younger (< 65). Values considered significant at p ≤ 0.05.
    Results: 557 suicide attempts were identified with 9% among Older patients. Most patients were male with median age of 75 years for Older and 35 years for Younger cohort, with similar length of stay (LOS) and injury severity scores (ISS). Penetrating injury was more common among Older patients with firearm used most often, 34% vs 14% for Younger. Differences were evident between male and female Older patients with ISS 16.7 vs 5, p < 0.01 and mortality, p = 0.03. The outcome of discharge to home was significantly different between Older and Younger, 6% vs 20% (p < 0.05). A difference in mortality was evident, Older 38% vs Younger 18% (p < 0.05).
    Conclusion: With the growing aging population, it is important to acknowledge the resultant increase in concomitant mental health issues and suicidality among older patients, where depression may be undiagnosed and untreated. Providing care within this cohort may reduce future attempts and lessen the burden on the health care system.
    MeSH term(s) Aged ; Female ; Humans ; Injury Severity Score ; Male ; Retrospective Studies ; Self Mutilation ; Self-Injurious Behavior/epidemiology ; Suicide, Attempted
    Language English
    Publishing date 2021-09-20
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2556794-9
    ISSN 1878-7657 ; 1878-7649
    ISSN (online) 1878-7657
    ISSN 1878-7649
    DOI 10.1007/s41999-021-00561-w
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  5. Article: Falls from a balcony while intoxicated: a new injury trend among young adults?

    Schaffer, Kathryn B / Schwendig, Gary / Nasrallah, Fady / Wang, Jiayan / Kraus, Jess F

    Injury epidemiology

    2019  Volume 6, Page(s) 4

    Abstract: Background: Unintentional falls from heights, including balconies, result in life threatening traumatic injury. Alcohol, when combined with environmental factors and poor judgement, can potentially lead to fatal outcomes. One trauma center's registry ... ...

    Abstract Background: Unintentional falls from heights, including balconies, result in life threatening traumatic injury. Alcohol, when combined with environmental factors and poor judgement, can potentially lead to fatal outcomes. One trauma center's registry identified a group of young adults falling from balconies and we investigated the role of alcohol.
    Methods: Hospital trauma service admissions from 2010 through 2017 were reviewed for unintentional falls from heights. Suicide attempts and unintentional falls off ladders or roofs were excluded. Data were obtained from trauma registry and medical record review, as well as social work service interviews.
    Results: Falls from heights comprised 4.8% of injuries treated at our trauma center during the eight-year study period with 98.5% admitted. Of patients admitted because of falls, 10.3% (55/532) were from a balcony. The majority of this group of patients was male and 19-29 years old (67%). Of patients with a blood alcohol concentration (BAC) determination, 62% had a positive BAC upon hospital admission with an average of 0.20 g/dL among those 34 patients. No gender differences were evident for alcohol use. Seven of the eight patients under the legal drinking age of 21 years were a subgroup with high alcohol use as compared with patients 21 years and older (
    Conclusions: Falls from balconies among young adults occur in our area yet the true frequency of these events remain unknown. Occurrence was most common among underage drinkers. Generalization is difficult with this small sample, yet high risk behaviors and environmental factors were evident. It is imperative that educational programs focus on this population with collaborative prevention efforts focused on the dangers of, and increased risk of injury associated with the balcony environment.
    Language English
    Publishing date 2019-02-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2764253-7
    ISSN 2197-1714
    ISSN 2197-1714
    DOI 10.1186/s40621-019-0181-3
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  6. Article ; Online: Pain management on a trauma service: a crisis reveals opportunities.

    Schaffer, Sabina / Bayat, Dunya / Biffl, Walter L / Smith, Jeffrey / Schaffer, Kathryn B / Dandan, Tala H / Wang, Jiayan / Snyder, Deb / Nalick, Chris / Dandan, Imad S / Tominaga, Gail T / Castelo, Matthew R

    Trauma surgery & acute care open

    2022  Volume 7, Issue 1, Page(s) e000862

    Abstract: Objectives: The opioid crisis has forced an examination of opioid prescribing and usage patterns. Multimodal pain management and limited, procedure-specific prescribing guidelines have been proposed in general surgery but are less well studied in trauma, ...

    Abstract Objectives: The opioid crisis has forced an examination of opioid prescribing and usage patterns. Multimodal pain management and limited, procedure-specific prescribing guidelines have been proposed in general surgery but are less well studied in trauma, where multisystem injuries and multispecialty caregivers are the norm. We hypothesized that opioid requirements would differ by primary type of injury and by age, and we sought to identify factors affecting opioid prescribing at discharge (DC).
    Methods: Retrospective analysis of pain management at a level II trauma center for January-November 2018. Consecutive patients with exploratory laparotomy (LAP); 3 or more rib fractures (fxs) (RIB); or pelvic (PEL), femoral (FEM), or tibial (TIB) fxs were included, and assigned to cohorts based on the predominant injury. Patients who died or had head Abbreviated Injury Scale >2 and Glasgow Coma Scale <15 were excluded. All pain medications were recorded daily; doses were converted to oral morphine equivalents (OMEs). The primary outcomes of interest were OMEs administered over the final 72 hours of hospitalization (OME72) and prescribed at DC (OMEDC). Multimodal pain therapy defined as 3 or more drugs used. Categorical variables and continuous variables were analyzed with appropriate statistical analyses.
    Results: 208 patients were included: 17 LAP, 106 RIB, 31 PEL, 26 FEM, and 28 TIB. 74% were male and 8% were using opiates prior to admission. Injury cohorts varied by age but not Injury Severity Score (ISS) or length of stay (LOS). 64% of patients received multimodal pain therapy. There was an overall difference in OME72 between the five injury groups (p<0.0001) and OME72 was lower for RIB compared with all other cohorts. Compared with younger (age <65) patients, older (≥65 years) patients had similar ISS and LOS, but lower OME72 (45 vs 135*) and OMEDC. Median OME72 differed significantly between older and younger patients with PEL (p=0.02) and RIB (p=0.01) injuries. No relationship existed between OMEDC across injury groups, by sex or injury severity. Patients were discharged almost exclusively by trauma service advanced practice clinicians (APCs). There was no difference among APCs in number of pills or OMEs prescribed. 81% of patients received opioids at DC, of whom 69% were prescribed an opioid/acetaminophen combination drug; and only 13% were prescribed non-steroidal anti-inflammatory drugs, 19% acetaminophen, and 31% gabapentin.
    Conclusions: Opioid usage varied among patients with different injury types. Opioid DC prescribing appears rote and does not correlate with actual opioid usage during the 72 hours prior to DC. Paradoxically, OMEDC tends to be higher among females, patients with ISS <16, and those with rib fxs, despite a tendency toward lower OME72 usage among these groups. There was apparent underutilization of non-opioid agents. These findings highlight opportunities for improvement and further study.
    Level of evidence: IV.
    Language English
    Publishing date 2022-03-24
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2021-000862
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  7. Article ; Online: A comparison of management and outcomes following blunt versus penetrating pancreatic trauma: A secondary analysis from the Western Trauma Association Multicenter Trials Group on Pancreatic Injuries.

    Biffl, Walter L / Ball, Chad G / Moore, Ernest E / West, Michaela / Russo, Rachel M / Balogh, Zsolt / Kornblith, Lucy / Callcut, Rachael / Schaffer, Kathryn B / Castelo, Matthew

    The journal of trauma and acute care surgery

    2022  Volume 93, Issue 5, Page(s) 620–626

    Abstract: Background: The impact of injury mechanism on outcomes of pancreatic trauma has not been well studied, and current guidelines do not differentiate recommendations for blunt and penetrating injuries. The purpose of this study was to analyze interventions ...

    Abstract Background: The impact of injury mechanism on outcomes of pancreatic trauma has not been well studied, and current guidelines do not differentiate recommendations for blunt and penetrating injuries. The purpose of this study was to analyze interventions and outcomes as they relate to mechanism. We hypothesized that penetrating pancreatic trauma results in greater morbidity than blunt trauma because of more frequent operative exploration without imaging and thus more aggressive surgical management.
    Methods: Secondary analysis of a multicenter retrospective review of pancreatic injuries in patients 15 years and older from 2010 to 2018 was performed. Deaths within 24 hours of admission were excluded from analysis of the primary outcome, pancreas-related complications (PRCs). Data were analyzed by injury mechanism using various statistical tests where appropriate.
    Results: Thirty-three centers reported on 1,240 patients (44% penetrating). Penetrating trauma patients were twice as likely to undergo resection (45% vs. 23%) and suffer PRCs (39% vs. 20%). However, differences varied widely based on injury grade and management. There were fewer resections and more nonoperative management in blunt grades I to III injury. Pancreas-related complications occurred in 40% of high-grade injuries with no difference between mechanisms and in 40% of patients after resection, regardless of mechanism or injury grade. High-grade pancreatic injury (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.55-3.67), penetrating injury (OR, 1.99; 95% CI, 1.31-3.05), and management in a low-volume center (i.e., five or fewer cases/year) (OR, 1.65; 95% CI, 1.16-2.35) were independent predictors of PRCs.
    Conclusion: Management of grades I to III, but not grades IV/V, pancreatic injuries varies based on mechanism. Penetrating injury is an independent risk factor for PRCs, but main pancreatic duct injury and resection are associated with high rates of PRCs regardless of the injury mechanism. Resection appears to offer better outcomes for grade IV/V injuries, and grade I and II injuries should be managed nonoperatively.
    Level of evidence: Therapeutic/Care Management; Level III.
    MeSH term(s) Humans ; Abdominal Injuries/diagnosis ; Abdominal Injuries/surgery ; Wounds, Penetrating/diagnosis ; Wounds, Penetrating/surgery ; Pancreas/surgery ; Pancreas/injuries ; Wounds, Nonpenetrating/therapy ; Wounds, Nonpenetrating/surgery ; Pancreatic Diseases ; Thoracic Injuries ; Retrospective Studies
    Language English
    Publishing date 2022-04-21
    Publishing country United States
    Document type Multicenter Study ; Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000003651
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  8. Article: Disparities in triage and management of the homeless and the elderly trauma patient.

    Schaffer, Kathryn B / Wang, Jiayan / Nasrallah, Fady S / Bayat, Dunya / Dandan, Tala / Ferkich, Anthony / Biffl, Walter L

    Injury epidemiology

    2020  Volume 7, Issue 1, Page(s) 39

    Abstract: Background: Trauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community.: Methods: A ...

    Abstract Background: Trauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community.
    Methods: A retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed.
    Results: Of 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates.
    Conclusions: Homeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to pre-existing health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.
    Language English
    Publishing date 2020-07-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2764253-7
    ISSN 2197-1714
    ISSN 2197-1714
    DOI 10.1186/s40621-020-00262-1
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  9. Article ; Online: Outcomes of severely injured pregnant trauma patients: a multicenter analysis.

    Awad, Kyrillos G / Nahmias, Jeffry / Aryan, Negaar / Lucas, Alexa N / Fierro, Nicole / Dhillon, Navpreet K / Ley, Eric J / Smith, Jennifer / Burruss, Sigrid / Dahan, Alden / Johnson, Arianne / Ganske, William / Biffl, Walter L / Bayat, Dunya / Castelo, Matthew / Wintz, Diane / Schaffer, Kathryn B / Zheng, Dennis J / Tillou, Areti /
    Coimbra, Raul / Tuli, Rahul / Santorelli, Jarrett E / Emigh, Brent / Schellenberg, Morgan / Inaba, Kenji / Duncan, Thomas K / Diaz, Graal / Tay-Lasso, Erika / Zezoff, Danielle C / Grigorian, Areg

    Updates in surgery

    2024  

    Abstract: Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs ... ...

    Abstract Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs with severe injuries will have higher rates of complications and mortality compared to less injured PTPs. A post-hoc analysis of a multi-institutional retrospective study at 12 Level-I/II trauma centers was performed. Patients were stratified into severely injured (injury severity score [ISS] > 15) and not severely injured (ISS < 15) and compared with bivariate analyses. From 950 patients, 32 (3.4%) had severe injuries. Compared to non-severely injured PTPs, severely injured PTPs were of similar maternal age but had younger gestational age (21 vs 26 weeks, p = 0.009). Penetrating trauma was more common in the severely injured cohort (15.6% vs 1.4%, p < 0.001). The severely injured cohort more often underwent an operation (68.8% vs 3.8%, p < 0.001), including a hysterectomy (6.3% vs 0.3%, p < 0.001). The severely injured group had higher rates of complications (34.4% vs 0.9%, p < 0.001), mortality (15.6% vs 0.1%, p < 0.001), a higher rate of fetal delivery (37.5% vs. 6.0%, p < 0.001) and resuscitative hysterotomy (9.4% vs. 0%, p < 0.001). Only approximately 3% of PTPs were severely injured. However, severely injured PTPs had a nearly 40% rate of fetal delivery as well as increased complications and mortality. This included a resuscitative hysterotomy rate of nearly 10%. Significant vigilance must remain when caring for this population.
    Language English
    Publishing date 2024-03-30
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-024-01817-3
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  10. Article ; Online: Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients.

    Dandan, Imad S / Tominaga, Gail T / Zhao, Frank Z / Schaffer, Kathryn B / Nasrallah, Fady S / Gawlik, Melanie / Bayat, Dunya / Dandan, Tala H / Biffl, Walter L

    Trauma surgery & acute care open

    2021  Volume 6, Issue 1, Page(s) e000670

    Abstract: Background: Overtriage of trauma patients is unavoidable and requires effective use of hospital resources. A 'pit stop' (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate ... ...

    Abstract Background: Overtriage of trauma patients is unavoidable and requires effective use of hospital resources. A 'pit stop' (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate evaluation by the emergency department (ED) physician and trauma nursing. We hypothesized this would allow for faster diagnostic testing and disposition while decreasing cost.
    Methods: We performed a before/after retrospective comparison after PS implementation. Patients not meeting trauma activation (TA) criteria but requiring trauma center evaluation were assigned as a TR for an expedited PS evaluation. A board-certified ED physician and trauma/ED nurse performed an immediate assessment in the trauma bay followed by performance of diagnostic studies. Trauma surgeons were readily available in case of upgrade to TA. We compared patient demographics, Injury Severity Score, time to physician evaluation, time to CT scan, hospital length of stay, and in-hospital mortality. Comparisons were made using 95% CI for variance and SD and unpaired t-tests for two-tailed p values, with statistical difference, p<0.05.
    Results: There were 994 TAs and 474 TRs in the first 9 months after implementation. TR's preanalysis versus postanalysis of the TR group shows similar mean door to physician evaluation times (6.9 vs. 8.6 minutes, p=0.1084). Mean door to CT time significantly decreased (67.7 vs. 50 minutes, p<0.001). 346 (73%) TR patients were discharged from ED; 2 (0.4%) were upgraded on arrival. When admitted, TR patients were older (61.4 vs. 47.2 years, p<0.0001) and more often involved in a same-level fall (59.5% vs. 20.1%, p<0.0001). Undertriage was calculated using the Cribari matrix at 3.2%.
    Discussion: PS implementation allowed for faster door to CT time for trauma patients not meeting activation criteria without mobilizing trauma team resources. This approach is safe, feasible, and simultaneously decreases hospital cost while improving allocation of trauma team resources.
    Level of evidence: Level II, economic/decision therapeutic/care management study.
    Language English
    Publishing date 2021-04-28
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2020-000670
    Database MEDical Literature Analysis and Retrieval System OnLINE

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