Injury
-
Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture. ⋯ Geriatric patients with rib fractures and an RCRI ≥1 represent a vulnerable and high-risk group. This index may inform the decision to admit for inpatient care and can also guide patient and family counseling as well as computer-based decision-support.
-
Because the proportion of trauma patients developing alcohol withdrawal syndrome (AWS) is low, AWS risk conditions have not been precisely delineated. We aimed to create multifactor screening strategies to assess probabilities for the likelihood of developing AWS. ⋯ AWS in the setting of traumatic injury is associated with multiple risk conditions. The presence of multiple risk conditions might have additive effects that could contribute toward a clinical manifestation of AWS. The identified risk conditions may be associated with a hyperadrenergic state.
-
In many rural trauma systems injured patients are initially evaluated at a local hospital, and once stabilized transferred to a trauma center for definitive care. In the U.S. most trauma transfers occur as emergency department (ED) to ED transfers, however there is little evidence to guide systems in whether this is beneficial. We implemented a practice change in August 2018, changing from commonly admitting trauma transfers directly to the floor, to a protocol for ED to ED transfer for all trauma patients. We aimed to evaluate this practice change and its effects on outcomes and ED length of stay. ⋯ Implementing an ED pitstop protocol for trauma transfers led to decreased direct admissions, without increasing the ED length of stay, and less need for delayed imaging.
-
Patients with head trauma who take antiplatelet or anticoagulant (APAC) agents have a higher rate of mortality. However, the association between these agents and mortality among blunt torso trauma patients without severe traumatic brain injury remains unclear. ⋯ The use of APAC agents before the injury was not associated with higher in-hospital mortality among blunt torso trauma patients without severe traumatic brain injury.
-
Computed tomography (CT) of the chest (CTC), abdomen, and pelvis (CTAP) is common when assessing trauma patients in the emergency department. However, unnecessary imaging can expose patients to unneeded radiation and increase healthcare costs. Here, we characterize the use of torso CT imaging for the evaluation of ground level falls (GLF) at a single level 1 trauma center. ⋯ Using PE, CXR, and PXR as a screening tool in patients sustaining GLF, which if negative close to obviates the need for torso CT, may reduce healthcare costs and radiation exposure without compromising patient care.