An Analysis of Beta-Blocker Administration Pre-and Post-Traumatic Brain Injury with Subanalyses for Head Injury Severity and Myocardial Injury.

A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and postinjury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried.

Big children or little adults? A statewide analysis of adolescent isolated severe traumatic brain injury outcomes at pediatric versus adult trauma centers.

Background: The appropriate managing center for adolescent trauma patients is debated. We sought to determine whether outcome differences existed for adolescent severe traumatic brain injury (sTBI) patients treated at pediatric versus adult trauma centers. We hypothesized that no difference in mortality, functional status at discharge (FSD), or overall complication rate would be observed between center types.

Hyponatremia as a fall predictor in a geriatric trauma population.

Introduction: Approximately one in three older adults fall each year, resulting in a significant proportion of geriatric traumatic injuries. In a hospital with a focus on geriatric fall prevention, we sought to characterize this population to develop targeted interventions. As mild hyponatremia, defined as a serum sodium <135meq/L, has been reported to be associated with falls, unsteadiness and attention deficits, we hypothesized that hyponatremia is associated with falls in our geriatric trauma population.

Checklist-styled daily sign-out rounds improve hospital throughput in a major trauma center.

The checklist concept has received much attention as a result of its ability to improve patient care by minimizing complications. We hypothesized daily sign-out rounds using a checklist, by improving team communication and consistency of clinical care, could lead to expedited throughput for patients at a major trauma center. A retrospective study examined patients admitted to a mature trauma center.

Prothrombin complex concentrate accelerates international normalized ratio reversal and diminishes the extension of intracranial hemorrhage in geriatric trauma patients.

Warfarin therapy increases the incidence intracranial hemorrhage (ICH), especially in the geriatric population. Timely reversal of international normalized ratio (INR) is integral in the management of these patients for whom fresh frozen plasma (FFP) with vitamin K is the standard of treatment. We hypothesized that implementing a protocol that used prothrombin complex concentrate (PCC) would reverse INR values more swiftly and decrease the amount of FFP administered.

Breaking down the barriers! Factors contributing to barrier days in a mature trauma center.

Background: As we enter the brave new world of the Patient Protection and Affordable Care Act of 2010, it is imperative that trauma centers provide not only excellent but also cost-effective trauma care. To that end, we sought to determine those factors that contribute significantly to barrier days (BDs), when a patient is medically cleared for discharge but unable to leave the hospital. We hypothesized that there would be significant demographic and payor factors associated with BDs.

Factors associated with patient satisfaction scores for physician care in trauma patients.

Background: The Affordable Care Act of 2010 identifies "patient experience of care" as one of five domains of excellent care. We hypothesized that there are specific demographic factors associated with higher or lower physician satisfaction (PS) scores in trauma patients.

Methods: Press-Ganey PS scores for September 2004 to December 2010 were compared with trauma variables and the association of a mean PS greater than or equal to 75 (high score) or less than or equal to 50 (low score).

Acute care and trauma surgeons: we can't get no satisfaction--what do satisfaction surveys measure?

Patient satisfaction surveys are increasingly being used as a measure of physician performance in a hospital setting. We sought to determine what role the clinical condition the physician is treating has on overall patient satisfaction scores. Patient satisfaction scores were calculated for elective and emergent general surgery and trauma patients for eight surgeons taking care of all three types of patients.

Old and undertriaged: a lethal combination.

The geriatric trauma patient poses unique challenges to the trauma surgeon due to occult injuries and occult hypoperfusion. We hypothesized that those elderly patients with significant injuries, who were not initially evaluated via trauma activation, would suffer worse outcomes. All cases of elderly (age ≥ 65) admitted to the trauma service from the years 2000 to 2010 were included.

In a mature trauma system, there is no difference in outcome (survival) between Level I and Level II trauma centers.

Background: The state of Pennsylvania (PA) has one of the oldest, most well-established trauma systems in the country. The requirements for verification for Level I versus Level II trauma centers within PA differ minimally (only in the requirement for patient volume, residency, and research). We hypothesized that there would be no difference in outcome at Level I versus Level II trauma centers.

Does prehospital prolonged extrication (entrapment) place trauma patients at higher risk for venous thromboembolism?

Background: The aim of this study was to determine if prolonged immobility and tissue injury from a prehospital entrapment would place patients at higher risk for in-hospital venous thromboembolism (VTE) complications. It was hypothesized that entrapment would increase in-hospital VTE.

Methods: All consecutive trauma admissions over a 10-year period were retrospectively reviewed.