Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for Physical Abuse.

Objectives: Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury.

Methods: Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included.

Evaluation of oral health education programs for oral health of individuals with visual impairment: An umbrella review.

Aim: To exemplify, summarize and critically appraise the systematic reviews (SRs) that evaluated different oral health education (OHE) interventions in individuals with visual impairment (VI).

Methodology: Six electronic databases were searched for SRs evaluating OHE programs in individuals with VI. The internal validity of the included SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool.

Pregnancy in trauma-A Western Trauma Association algorithm.

Background: The Western Trauma Association has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports, and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed because of complexity, ethical issues, financial considerations or scarcity of experience.

Infectious outcomes after splenectomy for trauma, splenectomy for disease and splenectomy with distal pancreatectomy.

Introduction: The spleen provides a unique immune function in its production of opsins directed against encapsulated bacteria. Splenectomy, therefore, increases the risk of infections in patients as well as post-operative complications. This study aims to assess the risk of post-operative complications within 5 years of splenectomy by indication for splenectomy: trauma, disease, or in association with a distal pancreatectomy for pancreatic disease.

The International Classification of Disease Critical Care Severity Score demonstrates that pediatric burden of injury is similar to that of adults: Validation using the National Trauma Databank.

Background/purpose: Resource-based severity of injury (SOI) measures, such as the International Classification of Disease (ICD) Critical Care Severity Score (ICASS), may characterize traumatic burden better than standard mortality-based measures. The purpose of this study was to validate the ICASS in a representative national-level trauma cohort and compare SOI measures between children and adults.

Methods: The National Trauma Databank was used to derive (2008-12) and validate (2013-15) ICASS and ICD Injury Severity Scores (ICISS, standard mortality-based SOI measure).

Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury.

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model.

Penetrating Vertebral Artery Injuries: A Literature Review and Proposed Treatment Algorithm.

Background: Penetrating vertebral artery injuries (VAIs) are rare but devastating trauma for which the approach to treatment varies greatly. The literature on treatment modalities is limited to case reports, case series, and 1 review, with the majority of cases being treated surgically. However, with the advent of digital subtraction angiography, treatment has shifted toward less invasive endovascular modalities that allows one to assess the flow and risks of sacrificing the vertebral artery (VA).

Quality Improvement Project of a Massive Transfusion Protocol (MTP) to Reduce Wastage of Blood Components.

Massive transfusion protocols (MTPs) facilitate the organized delivery of blood components for traumatically injured patients. MTPs vary across institutions, and ratios of blood components can change during clinical management. As a result, significant amounts of components can be wasted.

Two novel resource-based metrics to quantify pediatric trauma severity based on probability of requiring critical care and anesthesia services.

Background: Mortality-based metrics like the International Classification of Diseases (ICD) Injury Severity Score (ICISS) may underestimate burden of pediatric traumatic disease due to lower mortality rates in children. The purpose of this study was to develop and validate two resource-based severity of injury (SOI) measures, then compare these measures and the ICISS across a broad age spectrum of injured patients.

Methods: The ICISS and two novel SOI measures, termed ICD Critical Care Severity Score (ICASS) and ICD General Anesthesia Severity Score (IGASS), were derived from Florida state administrative 2012 to 2016 data and validated with 2017 data.

Should Hypotensive Trauma Patients Ever Be Transferred to a Trauma Center?

Many trauma patients present to nontrauma centers with emergency conditions. The Emergency Medical Treatment and Active Labor Act dictates that nontrauma centers attempt stabilization and provide appropriate transfer. Our goal was to determine whether there was a survival benefit in transferring hypotensive patients.

Risk factors for avoidable transfer to a pediatric trauma center among patients 2 years and older.

Background: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida.

Immature patients in a mature system: Regional analysis of Florida's pediatric trauma system.

Background: The state of Florida's trauma system is organized into seven regions, two of which lack designated pediatric trauma centers. Injured children residing in these regions often require transfer out of their home region for definitive care. The purpose of this study was to evaluate the effectiveness and efficiency of the current regionalization approach, focusing on variations between regions.

Effect of hospital type on the treatment of acute appendicitis in teenagers.

Background: Teenagers receive appendicitis care at both adult and pediatric facilities. The purpose of this study was to evaluate outcomes following treatment of acute appendicitis in teenagers based on the type of hospital facility.

Methods: Patients aged 13-17years with acute appendicitis who were discharged from acute care hospitals from 2009 to 2014 were identified using a statewide discharge dataset.

The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

Introduction: Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles.

The American College of Surgeons Needs-Based Assessment of Trauma Systems: Estimates for the State of California.

Background: In 2015, the American College of Surgeons Committee on Trauma convened a consensus conference to develop the Needs-Based Assessment of Trauma Systems (NBATS) tool to assist in determining the number of trauma centers required for a region. We tested the performance of NBATS with respect to the optimal number of trauma centers needed by region in California.

Methods: Trauma center data were obtained from the California Emergency Services Authority Information Systems (CEMSIS).

A closer look at non-accidental trauma: Caregiver assault compared to non-caregiver assault.

Purpose: The purpose of this study was to examine the outcomes of non-accidental trauma (NAT) patients compared to other trauma (OT) patients across the state of Florida. In addition, NAT and OT patients with a mechanism of injury of assault were further analyzed.

Methods: A statewide database was reviewed from January 2010 to December 2014 for patients aged 0-18years who presented following trauma.