Physician concussion knowledge and the effect of mailing the CDC's "Heads Up" toolkit.

Background: The Centers for Disease Control and Prevention's (CDC) "Heads Up" toolkit was designed to educate physicians about concussion, but it has not been well studied. This study proposed to evaluate the effect of receiving the toolkit on physician concussion knowledge.

Methods: The authors obtained a sample of physicians from the American Medical Association masterfile and randomly selected half to be mailed the CDC's "Heads Up" toolkit.

Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma.

Objective: The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions.

Method: We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy.

Variation in pediatric head CT imaging protocols in Washington state.

Purpose: To examine variation in pediatric trauma head CT imaging protocols in Washington state.

Methods: A web-based survey was sent to trauma-designated hospitals in Washington state. Respondents were queried about pediatric head trauma volumes, type of CT scanners, and technical information about the CT imaging protocols.

Long-term survival of adult trauma patients.

Context: Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge.

Objectives: To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition.

Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set.

Purpose: To our knowledge data on diagnostic angiography and angioembolization after renal trauma have been limited to single institution series with small numbers. We used the National Trauma Data Bank® to investigate national patterns of diagnostic angiography and angioembolization after blunt and penetrating renal trauma.

Materials And Methods: All renal injuries treated between 2002 and 2007 were identified in the National Trauma Data Bank by Abbreviated Injury Scale codes and converted to American Association for the Surgery of Trauma renal injury grades.

Comparison of telephone with World Wide Web-based responses by parents and teens to a follow-up survey after injury.

Objective: To identify sociodemographic factors associated with completing a follow-up survey about health status on the web versus by telephone, and to examine differences in reported health-related quality of life by method of response.

Data Sources/study Settings: Survey about child health status of 896 parents of children aged 0-17 years treated in a hospital emergency department or admitted for a traumatic brain injury or arm injury, and 227 injured adolescents aged 14-17 years.

Study Design: The main outcomes were characteristics of those who completed a follow-up survey on the web versus by telephone and health-related quality of life by method of response.

Estimating the population impact of preventive interventions from randomized trials.

Growing concern about the limited generalizability of trials of preventive interventions has led to several proposals concerning the design, reporting, and interpretation of such trials. This paper presents an epidemiologic framework that highlights three key determinants of population impact of many prevention programs: the proportion of the population at risk who would be candidates for a generic intervention in routine use, the proportion of those candidates who are actually intervened on through a specific program, and the reduction in incidence produced by that program among recipients. It then describes how the design of a prevention trial relates to estimating these quantities.

Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments.

Context: Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI).

Objectives: To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity.

Design: Multisite US prospective cohort study.

Functional and psychosocial outcomes of older adults after burn injury: results from a multicenter database of severe burn injury.

A number of factors increase the susceptibility of older adults to burn injury. The majority of studies of older adults have focused on patient and injury factors related to mortality risk. However, little is known about the long-term functional and psychological outcomes of older adults after severe burn.

Influence of birth hospital on outcomes of ductal-dependent cardiac lesions.

Objective: The goal was to determine the effect of birth hospital pediatric cardiac specialty center status and neonatal level of care on 90-day mortality for infants with ductal-dependent congenital heart disease.

Methods: A population-based, retrospective, cohort study was conducted in Washington State in 1987-2006. All infants born in Washington with gestational ages of ≥32 weeks and birth weights of ≥1500 g who were admitted to a Washington hospital for the care of a congenital cardiac anomaly likely to be ductal dependent were included.

Physician consultation, multidisciplinary care, and 1-year mortality in Medicare recipients hospitalized with hip and lower extremity injuries.

Objective: To determine whether routine surgeon consultation with medicine specialists and multidisciplinary care conferences-potentially modifiable hospital characteristics-are associated with lower 1-year mortality in older adults with hip and lower extremity injuries.

Design: Retrospective cohort study.

Setting: Oregon hospitals.

Variations in U.S. pediatric burn injury hospitalizations using the national burn repository data.

An understanding of population-specific variation in pediatric burn injuries is essential to the development of effective prevention strategies. The purpose of this study was to examine the etiology of pediatric burn injury considering age and race categories using the National Burn Repository. The authors reviewed the records of all pediatric patients (age <18 years) in the American Burn Association's National Burn Registry injured between 1995 and 2007.

Development and validation of the mortality risk for trauma comorbidity index.

Objective: The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury.

Summary Background Data: Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies.

The value of trauma center care.

Background: The cost of trauma center care is high, raising questions about the value of a regionalized approach to trauma care. To address these concerns, we estimate 1-year and lifetime treatment costs and measure the cost-effectiveness of treatment at a Level I trauma center (TC) compared with a nontrauma center hospital (NTC).

Methods: Estimates of cost-effectiveness were derived using data on 5,043 major trauma patients enrolled in the National Study on Costs and Outcomes of Trauma, a prospective cohort study of severely injured adult patients cared for in 69 hospitals in 14 states.

Adult health and relationship outcomes among women with abuse experiences during childhood.

Associations between child abuse and/or witnessing intimate partner violence (IPV) during childhood and women's health, adult IPV exposure, and health care use were examined. Randomly sampled insured women ages 18-64 (N = 3,568) completed a phone interview assessing childhood exposure to abuse and witnessing IPV, current health, and adult IPV exposure. Women's health care use was collected from automated health plan databases.