Outcome of Hypotensive Trauma Patients by Time and Day of Arrival.

Background: Although most studies of trauma patients have not demonstrated a "weekend" or "night" effect on mortality, outcomes of hypotensive (systolic blood pressure <90 mm Hg) patients have not been studied. We sought to evaluate whether outcomes of hypotensive patients were associated with admission time and day.

Methods: We retrospectively analyzed patients from Pennsylvania Level 1 and Level 2 trauma centers with systolic blood pressure of <90 mm Hg over 5 y.

Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria.

Background: Geriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria.

Geriatric Patients on Antithrombotic Agents Who Fall: Does Trauma Team Activation Improve Outcomes?

Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls.

Is clinician assessment accurate or is routine pan-body CT needed in the stable intoxicated trauma patient?

Background: We sought to determine if clinician suspicion of injury was useful in predicting injuries found on pan-body computed tomography (PBCT) in clinically intoxicated patients.

Methods: We prospectively enrolled awake, intoxicated patients with low-energy mechanism of injury. For each of four body regions (head/face, neck, thorax and abdomen/pelvis), clinician suspicion for injury was recorded as "low index" or "more than a low index".

Fall downs should not fall out: Blunt cerebrovascular injury in geriatric patients after low-energy trauma is common.

Background: There are limited data examining the impact of screening for blunt cerebrovascular injury (BCVI) in the geriatric population sustaining falls. We hypothesize that BCVI screening in this cohort would rarely identify injuries that would change management.

Methods: A retrospective study (2012-2016) identified patients 65 years or older with Abbreviated Injury Scores for the head and neck region or face region of 1 or greater after falls of 5 ft or less.

Being Narrow Minded Is Not Always Bad: Focusing on Emergent Interventions in Undertriage Initiatives Improves Mortality Prediction.

The American College of Surgeons Committee on Trauma defines undertriage (UT) as any major trauma patient (injury severity score ≥ 16) not undergoing treatment at the highest level of trauma team activation. This methodology does not account for many important factors that may impact outcome. We performed a retrospective review of the Pennsylvania State Trauma Registry to determine the impact of treatment interventions on mortality.

Does Antithrombotic Drug Use Mandate Trauma Team Activation in Awake Geriatric Patients with Intracranial Hemorrhage?

Antithrombotic (anticoagulant [AC] and antiplatelet [AP]) drugs have been associated with mortality in geriatric patients with intracranial hemorrhage (ICH). It is unclear whether trauma team activation (TTA) in this cohort impacts outcome. Patients ≥65 years with a Glasgow Coma Scale of ≥13 and ICH over four years were included and were divided into three groups according to type of drug: group 1, AC with or without AP; group 2, AP only and; group 3, no AC or AP.

Is it safe to discharge geriatric trauma patients with anemia?

Introduction: The consequences of discharging anemic geriatric trauma patients are not well studied. We hypothesize that anemia at discharge is associated with adverse outcomes.

Methods: A 1-year retrospective review of patients ≥65 years was performed.

Trauma surgeon utilization of computerized tomography scanning: Room for improvement?

Background: We aimed to evaluate computerized tomography (CT) utilization and yield rates for trauma team activations (TTA).

Methods: A retrospective review of all TTAs was conducted over nine months. TTAs consisted of two levels--trauma alert (TAL) and trauma response (TR).

Advanced Practitioners Are Peers in Trauma Performance Improvement Peer Review.

Advanced practitioners (APs) have been successfully integrated into the clinical care of injured patients. Given the expanding role of APs in trauma care, we hypothesized that APs can perform Performance Improvement and Patient Safety (PIPS) peer review at a level comparable with trauma surgeons. For Phase 1, cases previously reviewed by a trauma surgeon were randomly selected by the PIPS coordinator and peer reviewed by an AP.

Nonoperative management of splenic injuries: significance of age.

Background: In the nonoperative management (NOM) of blunt splenic injuries (BSI), the clinical relevance of age as a risk factor has not been well studied.

Methods: Using the 2011 National Trauma Data Bank data set, age was analyzed both as a continuous variable and a categorical variable (group 1 [13-54 y], group 2 [55-74 y], and group 3 [≥75 y]). BSI severity was stratified by abbreviated injury scale (AIS): group 1 (AIS ≤2), group 2 (AIS 3), and group 3 (AIS ≥4).