Current patterns of trauma center proliferation have not led to proportionate improvements in access to care or mortality after injury: An ecologic study.

Background: Timely access to high-level (I/II) trauma centers (HLTCs) is essential to minimize mortality after injury. Over the last 15 years, there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality.

Frequency and Predictors of Trauma Transfer Futility to a Rural Level I Trauma Center.

Introduction: Transfer of trauma patients whose injuries are deemed unsurvivable, often results in early death or transition to comfort care and could be considered misuse of health care resources. This is particularly true where tertiary care resources are limited. Identifying riskfactors for and predicting futile transfers could reduce this impact and help to optimize triage and management.

Administration of epinephrine by advanced emergency medical technicians for out-of-hospital cardiac arrest in a rural emergency medical services system.

Objective: Epinephrine in out-of-hospital cardiac arrest (OHCA) remains controversial and understudied in rural emergency medical services (EMS) systems. We evaluated the effects of allowing advanced emergency medical technicians (AEMTs) to administer epinephrine during OHCA in a rural EMS system.

Methods: An interrupted time series study was conducted using statewide EMS electronic records.

Geographic Coverage and Verification of Trauma Centers in a Rural State: Highlighting the Utility of Location Allocationfor Trauma System Planning.

Background: Care at verified trauma centers has improved survival and functional outcomes, yet determining the appropriate location of potential trauma centers is often driven by factors other than optimizing system-level patient care. Given the importance of transport time in trauma, we analyzed trauma transport patterns in a rural state lacking an organized trauma system and implemented a geographic information system to inform potential future trauma center locations.

Study Design: Data were collected on trauma ground transport during a 3-year period (2014 through 2016) from the Statewide Incident Reporting Network database.

Practice Variation in Vena Cava Filter Use Among Trauma Centers in the National Trauma Database.

Background: Agreement regarding indications for vena cava filter (VCF) utilization in trauma patients has been in flux since the filter's introduction. As VCF technology and practice guidelines have evolved, the use of VCF in trauma patients has changed. This study examines variation in VCF placement among trauma centers.

Population-Based Analysis of Firearm Injuries among Young Children in the United States, 2010-2015.

Firearm violence in the United States knows no age limit. This study compares the survival of children younger than five years to children and adolescents of age 5-19 years who presented to an ED for gunshot wounds (GSWs) in the United States to test the hypothesis of higher GSW mortality in very young children. A study of GSW patients aged 19 years and younger who survived to reach medical care was performed using the Nationwide ED Sample for 2010-2015.

A trauma mortality prediction model based on the ICD-10-CM lexicon: TMPM-ICD10.

Background: Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described.

Methods: The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and Injury Severity Score (ISS).

Variation in readmission rates among hospitals following admission for traumatic injury.

Introduction: Readmission following hospital discharge is both common and costly. The Hospital Readmission Reduction Program (HRRP) financially penalizes hospitals for readmission following admission for some conditions, but this approach may not be appropriate for all conditions. We wished to determine if hospitals differed in their adjusted readmission rates following an index hospital admission for traumatic injury.

Comparisons of New HIV Rapid Test Kit Performance.

The development of rapid point-of-care tests for HIV infection has greatly reduced the problem of failure to return for test results. Test manufacturers are now developing test kits that can test for two or even three diseases at the same time, multiple-disease test kits. This study reports on the sensitivity and specificity of HIV tests when included on multi-disease test kits.

Gunshot wounds resulting in hospitalization in the United States: 2004-2013.

Introduction: The United States (US) leads all high income countries in gunshot wound (GSW) deaths. However, as a result of two decades of reduced federal support, study of GSW has been largely neglected. In this paper we describe the current state of GSW hospitalizations in the US using population-based data.

Failure to get into substance abuse treatment.

Among substance abusers in the US, the discrepancy in the number who access substance abuse treatment and the number who need treatment is sizable. This results in a major public health problem of access to treatment. The purpose of this study was to examine characteristics of Persons Who Use Drugs (PWUDs) that either hinder or facilitate access to treatment.

Summary goodness-of-fit statistics for binary generalized linear models with noncanonical link functions.

Generalized linear models (GLM) with a canonical logit link function are the primary modeling technique used to relate a binary outcome to predictor variables. However, noncanonical links can offer more flexibility, producing convenient analytical quantities (e.g.

Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts.

Importance: Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate.

Objective: To examine the effect of Massachusetts HCR on survival rates of injured patients.

Trauma care does not discriminate: The association of race and health insurance with mortality following traumatic injury.

Background: Previous studies have reported that black race and lack of health insurance coverage are associated with increased mortality following traumatic injury. However, the association of race and insurance status with trauma outcomes has not been examined using contemporary, national, population-based data.

Methods: We used data from the National Inpatient Sample on 215,615 patients admitted to 1 of 836 hospitals following traumatic injury in 2010.

Empirically based composite fracture prediction model from the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW).

Context: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired.

Objective: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles.

A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model.

Background: Performance benchmarking requires accurate measurement of injury severity. Despite its shortcomings, the Injury Severity Score (ISS) remains the industry standard 40 years after its creation. A new severity measure, the Trauma Mortality Prediction Model (TMPM), uses either the Abbreviated Injury Scale (AIS) or DRG International Classification of Diseases-9th Rev.

Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW).

Low body mass index (BMI) is a well-established risk factor for fracture in postmenopausal women. Height and obesity have also been associated with increased fracture risk at some sites. We investigated the relationships of weight, BMI, and height with incident clinical fracture in a practice-based cohort of postmenopausal women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW).

Estimated additional hospital length of stay caused by 40 individual complications in injured patients: an observational study of 204,388 patients.

Background: Complications are common in the care of trauma patients and increase hospital length of stay (LoS). Because many factors influence LoS and because patients may experience more than a single complication, it is difficult to estimate the effect of individual complications on LoS. We describe here a mathematically principled approach to estimating the additional LoS caused by complications and provide estimates for additional LoS caused by 40 common complications.

A goodness-of-fit test for the proportional odds regression model.

We examine goodness-of-fit tests for the proportional odds logistic regression model-the most commonly used regression model for an ordinal response variable. We derive a test statistic based on the Hosmer-Lemeshow test for binary logistic regression. Using a simulation study, we investigate the distribution and power properties of this test and compare these with those of three other goodness-of-fit tests.

Differing risk profiles for individual fracture sites: evidence from the Global Longitudinal Study of Osteoporosis in Women (GLOW).

The purposes of this study were to examine fracture risk profiles at specific bone sites, and to understand why model discrimination using clinical risk factors is generally better in hip fracture models than in models that combine hip with other bones. Using 3-year data from the GLOW study (54,229 women with more than 4400 total fractures), we present Cox regression model results for 10 individual fracture sites, for both any and first-time fracture, among women aged ≥55 years. Advanced age is the strongest risk factor in hip (hazard ratio [HR] = 2.

Complication-associated mortality following trauma: a population-based observational study.

Context: Complications are common in the care of trauma patients and contribute to morbidity, mortality, and cost. However, no comprehensive list of surgical complications is widely accepted.

Objectives: To create an empirical list of complications based on the International Classification of Diseases, Ninth Revision (ICD-9) lexicon and estimate the contribution of these complications to mortality.