The American surgeon
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The American surgeon · Jun 2021
A Handoff Protocol for Pediatric Trauma Patients at a Rural Level One Trauma Center Reduces Length of Stay.
The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff. ⋯ Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 (t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.
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The American surgeon · Apr 2021
Impact of COVID-19 Governmental Restrictions on Emergency General Surgery Operative Volume and Severity.
To describe the effect of the COVID-19 pandemic on emergency general surgery operative volumes during governmental shutdowns secondary to the pandemic and characterize differences in disease severity, morbidity, and mortality during this time compared to previous years. ⋯ This study demonstrates a decrease of 65% in emergency general surgery operations during governmental restrictions secondary to the COVID-19 pandemic. This decrease in operations was not associated with worse disease severity, morbidity, or mortality.
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The American surgeon · Apr 2021
Multicenter Study Comparative StudyIs NBATS-2 up to the Task? Actual vs. Predicted Patient Volume Shifts With the Addition of Another Trauma Center.
Version 2 of the Needs-Based Assessment of Trauma Systems (NBATS) tool quantifies the impact of an additional trauma center on a region. This study applies NBATS-2 to a system where an additional trauma center was added to compare the tool's predictions to actual patient volumes. ⋯ NBATS-2 failed to predict the post-period volume changes. Without a change in EMS destination guidelines, this finding was not surprising for severely injured patients. However, the 288% increase in volume of minor injuries was unexpected. NBATS-2 must be refined to assess the impact of local factors on patient volume.
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The American surgeon · Mar 2021
Undertriage Despite Use of Geriatric-Specific Trauma Team Activation Guidelines : Who Are We Missing?
Elderly trauma patients are at risk for undertriage, resulting in substantial morbidity and mortality. The objective of this study was to determine whether implementation of geriatric-specific trauma team activation (TTA) protocols appropriately identified severely-injured elderly patients. ⋯ Geriatric-specific TTA guidelines continue to undertriage elderly trauma patients when using ISS as a metric to measure undertriage. However, undertriaged patients have much lower morbidity and mortality, suggesting the geriatric-specific TTA guidelines identify those patients at highest risk for poor outcomes.