Back to the Future: Impact of a Paper-Based Admission H&P on Clinical Documentation Improvement at a Level 1 Trauma Center.

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI).

Community Need Index (CNI): a simple tool to predict emergency department utilization after hospital discharge from the trauma service.

Background: Emergency department (ED) visits after hospital discharge may reflect failure of transition of care to the outpatient setting. Reduction of postdischarge ED utilization represents an opportunity for quality improvement and cost reduction. The Community Need Index (CNI) is a Zip code-based score that accounts for a community's unmet needs with respect to healthcare and is publicly accessible via the internet.

Pneumomediastinum in blunt trauma: If aerodigestive injury is not seen on CT, invasive workup is not indicated.

Background: Pneumomediastinum following blunt trauma is often observed on CT imaging, and concern for associated aerodigestive injury often prompts endoscopy and/or fluoroscopy. In recent years, adoption of multi-detector CT technology has resulted in high resolution images that may clearly identify aerodigestive injuries. The purpose of this study was to evaluate the utility of multi-detector CT in the identification of blunt aerodigestive injuries.

Crisis under the radar: Illicit amphetamine use is reaching epidemic proportions and contributing to resource overutilization at a Level I trauma center.

Introduction: Trauma centers reported illicit amphetamine use in approximately 10% of trauma admissions in the previous decade. From experience at a trauma center located in a southwestern metropolis, our perception is that illicit amphetamine use is on the rise and that these patients utilize in-hospital resources beyond what would be expected for their injuries. The purposes of this study were to document the incidence of illicit amphetamine use among our trauma patients and to evaluate its impact on resource utilization.

Grey's Anatomy effect: television portrayal of patients with trauma may cultivate unrealistic patient and family expectations after injury.

Background: Expectations of the healthcare experience may be influenced by television dramas set in the hospital workplace. It is our perception that the fictional television portrayal of hospitalization after injury in such dramas is misrepresentative. The purpose of this study was to compare trauma outcomes on television dramas versus reality.

Health literacy and quality of physician-trauma patient communication: Opportunity for improvement.

Background: Although physician-patient communication and health literacy (HL) have been studied in diverse patient groups, there has been little focus on trauma patients. A quality improvement project was undertaken at our Level I trauma center to improve patient perception of physician-patient communication, with consideration of the effect of HL. We report the first phase of this project, namely the reference level of satisfaction with physician-patient communication as measured by levels of interpersonal care among patients at an urban Level I trauma center.

Risk factors for extubation failure at a level I trauma center: does the specialty of the intensivist matter?

Introduction: Extubation failure in critically ill patients is associated with higher morbidity and mortality. Although predictors of failed extubation have been previously determined in intensive care unit (ICU) cohorts, relatively less attention has been directed toward this issue in patients with trauma. The aim of this study was to identify predictors of extubation failure among patients with trauma in a multidisciplinary ICU setting.

The use of extracorporeal membrane oxygenation in blunt thoracic trauma: A study of the Extracorporeal Life Support Organization database.

Background: Reports documenting the use of extracorporeal membrane oxygenation (ECMO) after blunt thoracic trauma are scarce. We used a large, multicenter database to examine outcomes when ECMO was used in treating patients with blunt thoracic trauma.

Methods: We performed a retrospective analysis of ECMO patients in the Extracorporeal Life Support Organization database between 1998 and 2014.

"Corkscrew stenosis": defining and preventing a complication of percutaneous dilatational tracheostomy.

Objective: The short-term safety of percutaneous dilatational tracheostomy has been widely demonstrated. However, less is known about their long-term complications. Through an illustrative case series, we present and define "corkscrew stenosis," a type of tracheal stenosis uniquely associated with percutaneous dilatational tracheostomy.

Naturally occurring hypothermia is more advantageous than fever in severe forms of lipopolysaccharide- and Escherichia coli-induced systemic inflammation.

The natural switch from fever to hypothermia observed in the most severe cases of systemic inflammation is a phenomenon that continues to puzzle clinicians and scientists. The present study was the first to evaluate in direct experiments how the development of hypothermia vs. fever during severe forms of systemic inflammation impacts the pathophysiology of this malady and mortality rates in rats.

Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study.

Background: Occult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined.

Trauma-associated pneumonia in adult ventilated patients.

Background: The clinical pulmonary infection score (CPIS) and bronchoalveolar lavage (BAL) are 2 tools that have been validated to diagnose pneumonia in critically ill patients. However, the role of the CPIS in diagnosing trauma-associated pneumonia (TAP) remains in question.

Methods: This prospective observational study included all trauma patients who were ventilated for longer than 48 hours from September 2008 to September 2009.

Harm reduction and 12 steps: complementary, oppositional, or something in-between?

Background: Initially born of the desire to prevent the transmission of HIV among injection drug users, harm reduction presents a relatively new option for assisting individuals who struggle with drug and alcohol use. Twelve-step programs such as Alcoholics Anonymous (AA) are widely recognized as being a representative example of abstinence-based treatment and are often seen as oppositional to harm reduction.

Methods: The purpose of this study is to examine the ways in which harm reduction workers interpret the relationship between harm reduction and 12-step approaches to treatment.

Smoking in trauma patients: the effects on the incidence of sepsis, respiratory failure, organ failure, and mortality.

Background: There is a high percentage of smokers among trauma patients. Cigarette smoking has been associated with the development of acute lung injury and the adult respiratory distress syndrome in critically ill patients. It is also known that nicotine exerts immunosuppressive and anti-inflammatory effects with chronic use.

Nicotine administration and withdrawal affect survival in systemic inflammation models.

How different regimens of nicotine administration and withdrawal affect systemic inflammation is largely unknown. We studied the effects of chronic and acute nicotine administration and of nicotine withdrawal on the outcome of aseptic and septic systemic inflammation. Male C57BL/6 mice were implanted with subcutaneous osmotic pumps (to deliver nicotine) and intrabrain telemetry probes (to measure temperature).

Helmet use and associated spinal fractures in motorcycle crash victims.

Background: The effect of helmet use on the incidence of cervical and thoracic fractures sustained in motorcycle crashes remains controversial.

Methods: We retrospectively reviewed the incidence of these fractures in helmeted and nonhelmeted crash victims at a single Level I trauma hospital with a well-defined system for evaluating spinal fractures.

Results: Of 422 motorcycle crash victims treated during 3 years, 190 had a traumatic brain injury (TBI) and 75 sustained some form of spinal fracture.

Done vida--donate life: a surgeon's perspective of organ donation.

Background: This report is the Presidential Address of the 59th Annual Meeting of the Southwestern Surgical Congress. Organ donation is discussed from the perspective of a trauma surgeon, a prospective live organ donor and a father of a transplant recipient. Current issues to increase organ donation in the United States are addressed.

Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base.

Object: Skull base fractures are often associated with potentially devastating injuries to major neural arteries in the head and neck, but the incidence and pattern of this association are unknown.

Methods: Between April and September 2002, 1738 Level 1 trauma patients were admitted to St. Joseph's Hospital and Medical Center in Phoenix, Arizona.

Microsomal prostaglandin E synthase-1, ephrins, and ephrin kinases as suspected therapeutic targets in arthritis: exposed by "criminal profiling".

Feeding information obtained in one criminal case into the profile of another crime often helps to solve the latter. The literature on two different "crimes," namely, acute systemic inflammation and arthritis (including osteoarthritis [OA] and rheumatoid arthritis [RA] deals largely with the same "gang" of inflammatory mediators, such as prostaglandin (PG) E2. Early investigations suggested that microsomal PGE synthase-1 (mPGES-1; a terminal PGE2-synthesizing enzyme) plays a pivotal role in bacterial lipopolysaccharide (LPS)-induced systemic inflammation, but overlooked the possibility that the same enzyme could be involved in OA or RA.

Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives?

Background: In the rural setting, long distances may necessitate that a patient undergo emergency laparotomy before transfer to a regional trauma center for definitive management. The purpose of this study was to review the experience of three regional trauma centers with such treated patients.

Methods: This study was a retrospective chart review of patients who underwent emergency laparotomy for trauma before transfer, identified from the respective databases of participating centers over a 6-year period.