Browsing by Subject "Injury severity score"
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Item American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings(Radiological Society of North America, 2021) Lee, James T.; Slade, Emily; Uyeda, Jennifer; Steenburg, Scott D.; Chong, Suzanne T.; Tsai, Richard; Raptis, Demetrios; Linnau, Ken F.; Chinapuvvula, Naga R.; Dattwyler, Matthew P.; Dugan, Adam; Baghdanian, Arthur; Flink, Carl; Baghdanian, Armonde; LeBedis, Christina A.; Radiology and Imaging Sciences, School of MedicineBackground: Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose: To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods: Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results: This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011–2012 vs 2017–2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; P < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; P = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; P = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; P < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; P < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; P < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; P < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; P = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; P < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; P < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; P < .001). Conclusion: Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management.Item Association of Emergency Department Pediatric Readiness With Mortality to 1 Year Among Injured Children Treated at Trauma Centers(American Medical Association, 2022) Newgard, Craig D.; Lin, Amber; Goldhaber-Fiebert, Jeremy D.; Marin, Jennifer R.; Smith, McKenna; Cook, Jennifer N. B.; Mohr, Nicholas M.; Zonfrillo, Mark R.; Puapong, Devin; Papa, Linda; Cloutier, Robert L.; Burd, Randall S.; Pediatric Readiness Study Group; Surgery, School of MedicineImportance: There is substantial variability among emergency departments (EDs) in their readiness to care for acutely ill and injured children, including US trauma centers. While high ED pediatric readiness is associated with improved in-hospital survival among children treated at trauma centers, the association between high ED readiness and long-term outcomes is unknown. Objective: To evaluate the association between ED pediatric readiness and 1-year survival among injured children presenting to 146 trauma centers. Design, setting, and participants: In this retrospective cohort study, injured children younger than 18 years who were residents of 8 states with admission, transfer to, or injury-related death at one of 146 participating trauma centers were included. Children cared for in and outside their state of residence were included. Subgroups included those with an Injury Severity Score (ISS) of 16 or more; any Abbreviated Injury Scale (AIS) score of 3 or more; head AIS score of 3 or more; and need for early critical resources. Data were collected from January 2012 to December 2017, with follow-up to December 2018. Data were analyzed from January to July 2021. Exposures: ED pediatric readiness for the initial ED, measured using the weighted Pediatric Readiness Score (wPRS; range, 0-100) from the 2013 National Pediatric Readiness Project assessment. Main outcomes and measures: Time to death within 365 days. Results: Of 88 071 included children, 30 654 (34.8%) were female; 2114 (2.4%) were Asian, 16 730 (10.0%) were Black, and 49 496 (56.2%) were White; and the median (IQR) age was 11 (5-15) years. A total of 1974 (2.2%) died within 1 year of the initial ED visit, including 1768 (2.0%) during hospitalization and 206 (0.2%) following discharge. Subgroups included 12 752 (14.5%) with an ISS of 16 or more, 28 402 (32.2%) with any AIS score of 3 or more, 13 348 (15.2%) with a head AIS of 3 or more, and 9048 (10.3%) requiring early critical resources. Compared with EDs in the lowest wPRS quartile (32-69), children cared for in the highest wPRS quartile (95-100) had lower hazard of death to 1 year (adjusted hazard ratio [aHR], 0.70; 95% CI, 0.56-0.88). Supplemental analyses removing early deaths had similar results (aHR, 0.75; 95% CI, 0.56-0.996). Findings were consistent across subgroups and multiple sensitivity analyses. Conclusions and relevance: Children treated in high-readiness trauma center EDs after injury had a lower risk of death that persisted to 1 year. High ED readiness is independently associated with long-term survival among injured children.Item The Demographics of Non-motor Vehicle Associated Railway Injuries Seen at Trauma Centers in the United States 2007 - 2014(Cureus, 2019-10) Raymond, Jodi; Loder, Randall T.; Schneble, Christopher A.; Orthopaedic Surgery, School of MedicineIntroduction The majority of railway injury studies are limited by small sample size, restricted to a small geographical distribution, or located outside the United States (US). The aim of our study was to assess the demographic patterns associated with non-motor vehicle railway injuries in the US using a national trauma center database. Materials and Methods Data from the National Trauma Data Bank data from 2007 - 2014 were used; 3,506 patients were identified. For all statistical analyses, a p-value < 0.05 was considered significant. Results The patients were 81% male with an average age of 38.6 + 17.1 years and an Injury Severity Score (ISS) of 16.8 + 13.8. Males compared to females were younger (37.7 vs 42.5 years, p = 0.000002), had greater length of stays (12.7 vs 9.8 days, p = 0.000006), and higher ISS scores (17.1 vs 15.4, p = 0.0007). The geographic distribution within the US was most common in the South (32.0%) and least in the Northeast (18.9%). The racial composition was 67.5% White, 19.1% Black, 11.5% Hispanic/Latino, and 1.9% others. The most common mechanisms of injury were hitting/colliding with rolling stock (38.6%), followed by a fall in or from a train (19.5%), and collision with an object (13.5%). The majority of patients were pedestrians or passengers (68.5%); employees accounted for 12.5%. Although the majority were pedestrian/passengers for all regions, the Midwest had a greater proportion of employees (22.0%) compared to the other regions (7.8% to 12.2%) (p < 10-6), and thus injuries were more commonly work-related (24.6% vs 6.7% - 13.7%, p < 10-6). Work-related injuries were less severe (ISS 11.2 vs 17.3 - p < 10-6) and more commonly occurred due to a fall (32.8% vs 17.9%, p < 10-6). Alcohol and/or drug involvement was present in 40.7% and was less in those with work-related injuries (2.2%). Overall mortality was 6.4% and was less in those having a work-related injury (2.0 vs 6.6% p = 0.000004). Conclusion For non-motor vehicle USA railway injuries, the average age was 38.5 years; 80.6% were male. The injuries were least common in the Northeast and most common in the South. Racial distribution mirrored that of the US population. Alcohol involvement was present in 29%, lower than in previous studies. Mortality was 6.4%, also lower than previously reported.Item Sex-Based Disparities in Timeliness of Trauma Care and Discharge Disposition(American Medical Association, 2022) Ingram, Martha-Conley E.; Nagalla, Monica; Shan, Ying; Nasca, Brian J.; Thomas, Arielle C.; Reddy, Susheel; Bilimoria, Karl Y.; Stey, Anne; Surgery, School of MedicineImportance: Differences in time to diagnostic and therapeutic measures can contribute to disparities in outcomes. However, whether there is an association of timeliness by sex for trauma patients is unknown. Objective: To investigate whether sex-based differences in time to definitive interventions exist for trauma patients in the US and whether these differences are associated with outcomes. Design, setting, and participants: This was a retrospective cohort study conducted from July 2020 to July 2021, using the 2013 to 2016 Trauma Quality Improvement Program (TQIP) databases from level I to III trauma centers in the US. Patients 18 years or older with an Injury Severity Score (ISS) greater than 15 and who carried diagnoses of traumatic brain injury, intra-abdominal injury, pelvic fracture, femur fracture, and spinal injury as a result of their trauma were included in the study. Data were analyzed from July 2020 to July 2021. Main outcomes and measures: Primary outcomes assessed timeliness to interventions, using Wilcoxon signed rank and χ2 tests. Secondary outcomes included location of discharge after injury, using propensity score-matched generalized estimating equations modeling. Results: Of the 28 332 patients included, 20 002 (70.6%) were male patients (mean [SD] age, 43.3 [18.2] years) and 8330 (29.4%) were female patients (mean [SD] age, 48.5 [21.1] years), with significantly different distributions of ISS scores (ISS score 16-24: male patient, 10 622 [53.1%]; female patient, 4684 [56.2%]; ISS score 41-74: male patient, 2052 [10.3%]; female patient, 852 [10.2%]). Male patients more frequently had abdominal (4257 [21.3%] vs 1268 [15.2%]) and spinal cord (3989 [20.0%] vs 1274 [15.3%]) injuries, whereas female patients experienced greater proportions of femur (3670 [44.0%] vs 8422 [42.1%]) and pelvic (3970 [47.6%] vs 6963 [34.8%]) fractures. Female patients experienced significantly longer emergency department length of stay (median [IQR], 184 [92-314] minutes vs 172 [86-289] minutes; P < .001), longer time in pretriage (median [IQR], 52 [36-80] minutes vs 49 [34-77] minutes; P < .001), and increased likelihood of discharge to nursing or long-term care facilities instead of home after matching by age, ISS, mechanism, and injury type (male patient:female patient, odds ratio, 0.72; 95% CI, 0.67-0.78). Conclusions and relevance: Results of this cohort study suggest that female trauma patients experienced slightly longer delays in trauma care and had a higher likelihood of discharge to long-term care facilities than their male counterparts.