Background: Unintentional falls are the greatest cause of injury-related hospitalisation in adult patients. Frailty is an important contributor to fall risk and poor outcomes in both midlife and older adult trauma patients. Despite this, the incidence of frailty remains understudied among midlife adults, and the CDC fall screening guidelines are limited to older adults.
View Article and Find Full Text PDFBackground: Our acute care surgery team sustainably launched a pain management quality improvement project to reduce opioid prescriptions without affecting pain control in our elective surgery patients that was adopted on the inpatient acute care surgery service. Consequently, we implemented patient education on opioids and pain management aiming at decreasing opioid use without compromising pain management for acutely injured patients on the trauma service.
Methods: Trauma patients admitted from August 1, 2021, to July 31, 2022, and discharged to home were included.
Objective: To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes.
Background: mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible.
The purpose of the current study was to assess the impact of the Stepping On fall prevention program on the incidence of falls and frailty measures in older adults. Participants completed pre- and post-fall prevention program questionnaires and the Frail Scale Assessment at baseline and post-program. They also completed a follow-up questionnaire and Frail Scale Assessment at 6- and 12-month intervals post-program.
View Article and Find Full Text PDFBackground: Worse outcomes following injuries are more likely in rural versus urban areas. In 2001, our state established an inclusive trauma system to improve mortality. In 2015, the trauma system had a consultation visit from the American College of Surgeons' Committee on Trauma, who made several recommendations.
View Article and Find Full Text PDFPurpose: Midlife adults (50-64 y) are at risk for falls and subsequent injury; yet current guidance on fall screening only pertains to older adults (> 65 y). Herein, we evaluated whether frailty was predictive of readmission for falls in midlife trauma patients.
Study Design: This was a retrospective cohort study of trauma midlife patients admitted for traumatic injuries from 2010 to 2015.
Background: In patients with rib fractures, adverse outcomes are associated with number of rib fractures; however, studies suggest an association with frailty. We assessed whether frailty, measured using the Canadian Study of Health and Aging clinical frailty scale, was associated with adverse outcomes in this population.
Methods: Patients ≥50 years admitted for rib fractures from July 2015 to June 2020 were retrospectively scored for frailty.
Herein, we assessed the utility of the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) to predict burn-specific outcomes. We hypothesized that frail patients are at greater risk for burn-related complications and require increased healthcare support at discharge. Patients 50 years and older admitted to our institution for burn injuries between July 2009 and June 2019 were included.
View Article and Find Full Text PDFObjective: To compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days.
Summary Background Data: The Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status.
Objective: To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death.
Summary Background Data: Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential.
Methods: This retrospective cohort study used data from 9 level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints.
Uncontrolled bleeding is a preventable cause of death in rural trauma. Herein, we examined the appropriateness, effectiveness, and safety of tourniquet application for bleeding control in a rural trauma system. Medical records of adult patients admitted to our academic Level I trauma center between July 2015 and December 2018 were retrospectively reviewed.
View Article and Find Full Text PDFN Engl J Med
November 2020
Background: Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis.
Methods: We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S.
Background: Elderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly.
View Article and Find Full Text PDFWilderness Environ Med
September 2020
Introduction: Tree stand falls are a common injury among hunters. This study was designed to identify specific injury patterns and local and regional factors affecting access to and care for this unique trauma cohort in Iowa.
Methods: The University of Iowa trauma registry was retrospectively queried from 2004 to 2014 for patients with a mechanism of injury of fall from tree stands.
Introduction: Results of a quality improvement (QI) project to standardize our opioid prescribing practices following five common outpatient general surgery procedures are presented.
Methods: Opioid prescribing habits were reviewed from June to December 2017. QI measures were implemented.
Importance: Falls have been associated with morbidity and mortality in elderly patients. Assessment of frailty at hospital admission may help health care professionals evaluate fall risk in patients with trauma-related injury.
Objective: To determine whether frailty assessed using the Canadian Study of Health and Aging Clinical Frailty Scale is associated with readmission for falls after index admission for trauma-related injury in patients aged 50 years and older.
Background: The incidence of patients who present with life-threatening bleeding complications has been increasing as the use of direct oral anticoagulation (DOAC) has increased. Therefore, effective reversal agents are urgently needed. Current guidelines recommend the use of prothrombin complex concentrates (PCCs) and activated PCCs (aPCC) for reversal of DOAC anticoagulant activity in the setting of traumatic and non-traumatic intracranial hemorrhage (ICH).
View Article and Find Full Text PDFBackground: The purpose of this study was to determine the rates of initial vaccinations after splenectomy for trauma, assess the effectiveness of patient education on reimmunizations, and evaluate patients' utilization of their knowledge regarding immunization after discharge.
Methods: From June 1996-December 2011, 144 patients underwent splenectomy after traumatic injury. A telephone survey was completed in 100 of 144 splenectomized patients (69%) at a mean of 7.
Context: Necrotizing fasciitis is an aggressive infection affecting the skin and soft tissue. It has a very high acute mortality. The long-term survival and cause of death of patients who survive an index hospitalization for necrotizing fasciitis are not known.
View Article and Find Full Text PDFBackground: Acellular dermal matrix (ADM) represents a promising new fascial substitute for repairing abdominal wall defects.
Methods: We retrospectively studied 63 patients who underwent fascial reconstruction with ADM and analyzed risk factors for recurrence and infectious wound complications.
Results: Postoperative wound infections, noninfectious wound complications, and recurrences developed in 35%, 44%, and 41% of patients, respectively.
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