The Impact of Interdisciplinary Care on Cost Reduction in a Geriatric Trauma Population.

Unlabelled: The current growth of the geriatric population and increased burden on trauma services throughout the United States (US) has created a need for systems that can improve patient care and reduce hospital costs. We hypothesize that the multidisciplinary services provided through the Geriatric Injury Institute (GII) can reduce hospital costs, improve patient triage throughput, and decrease hospital length of stay (LOS).

Methods And Material: We performed a single-center, retrospective chart review of our Level II trauma center registry and electronic medical records of patients ages 65 and older who satisfied trauma activation/code criteria between July 1, 2014, to June 30, 2016 ( = 663).

When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims.

Background: Geriatric patients who fall while taking an anticoagulant have a small but significant risk of delayed intracranial hemorrhage requiring observation for 24 h. However, the medical complexity associated with geriatric care may necessitate a longer stay in the hospital. Little is known about the factors associated with a successful observational status stay (<2 d) for this population.

Is Pre-Hospital CPR a Risk Factor for Early Death in Patients Transferred to an Adult Burn Center?

Background: Burn patients who require CPR before admission to a burn center are anecdotally known to suffer higher mortality than those who do not require pre-hospital CPR.

Study Design: A retrospective chart review identified adult patients admitted to our burn center between 2013 and 2015. Included patients met 1 or both of the following criteria: 20% or more total body surface area burned and need for intubation before admission to our facility.

Trauma morning report is the ideal environment to teach and evaluate resident communication and sign-outs in the 80 hour work week.

Background: The 80h work week has raised concerns that complications may increase due to multiple sign-outs or poor communication. Trauma Surgery manages complex trauma and acute care surgical patients with rapidly changing physiology, clinical demands and a large volume of data that must be communicated to render safe, effective patient care. Trauma Morning Report format may offer the ideal situation to study and teach sign-outs and resident communication.

Teaching leadership in trauma resuscitation: Immediate feedback from a real-time, competency-based evaluation tool shows long-term improvement in resident performance.

Background: Limited data exist on how to develop resident leadership and communication skills during actual trauma resuscitations.

Methods: An evaluation tool was developed to grade senior resident performance as the team leader during full-trauma-team activations. Thirty actions that demonstrated the Accreditation Council for Graduate Medical Education core competencies were graded on a Likert scale of 1 (poor) to 5 (exceptional).

A case of pyogenic liver abscesses in a previously healthy adolescent man.

An 18-year-old, previously healthy man admitted with abdominal pain, high-grade fevers, nausea and emesis was found to have multiple hepatic abscesses. Aspiration cultures grew Fusobacterium necrophorum, a rare bacterium causing potentially fatal liver abscesses in humans. Following sequential percutaneous drainages and narrowing of antibiotics, the patient was discharged on a 6-week antibiotic course and showed no signs of infection.

Undiagnosed medical comorbidities in the uninsured: a significant predictor of mortality following trauma.

Background: Lack of health care insurance has been correlated with increased mortality after trauma. Medical comorbidities significantly affect trauma outcomes. Access to health care and thereby being diagnosed with a pretrauma comorbidity is highly dependent on insurance status.

Infections after trauma are associated with subsequent cardiac injury.

Background: Trauma produces profound inflammatory and immune responses. A second hit such as an infection further disrupts the inflammatory cascade. Inflammatory responses, following traumatic injuries, infections, or both, are emerging as biologic mediators of cardiac disease including myocardial ischemia and infarction.

The development of a urinary tract infection is associated with increased mortality in trauma patients.

Background: In October 2008, Medicare and Medicaid stopped paying for care associated with catheter-related urinary tract infections (UTIs). Although most clinicians agree UTIs are detrimental, there are little data to support this belief.

Methods: This is a retrospective review of trauma registry data from a Level I trauma center between 2003 and 2008.

Impact of socioethnic factors on outcomes following traumatic brain injury.

Background: Ethnic minorities and low income families tend to be in poorer health and have worse outcomes for a spectrum of diseases. Health care provider bias has been reported to potentially affect the distribution of care away from poorer communities, minorities, and patients with a history of substance abuse. Trauma is perceived as a disease of the poor and medically underserved.

Peritoneal free air due to evacuation of pneumobilia in blunt abdominal trauma.

Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures. Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity. In the present article, we report a case in which blunt abdominal trauma led to the evacuation of pre-existing pneumobilia causing pneumoperitoneum.

Normal presenting vital signs are unreliable in geriatric blunt trauma victims.

Background: Normal vital signs are typically associated with improved outcomes in trauma patients. Whether this association is true for geriatric patients is unclear.

Methods: A Level 1 trauma center retrospective chart review of vital signs on presentation (heart rate [HR] and blood pressure) in young (aged 17-35 years) and geriatric (aged 65 years or older) blunt trauma victims from September 2003 to September 2008 was preformed.

The multiply injured trauma patient: resuscitation, rehabilitation, recovery.

The care of the acutely injured patient requires a multidisciplinary approach from the moment of injury through rehabilitation and reintegration into society. In addition to the doctors and nurses providing many aspects of the acute and chronic medical care, the rehabilitation component is delivered by several skilled specialists focused on maximizing functional outcomes.

Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).

Objective: To determine the rate and predictors of failure of nonoperative management (NOM) in grade IV and V blunt splenic injuries (BSI).

Design: Retrospective case series.

Setting: Fourteen trauma centers in New England.

Ultrasound-guided peripheral intravenous access in the intensive care unit.

Purpose: Central venous catheters continue to be a popular means of maintaining vascular access in surgical intensive care units despite well-described complications. With edema, obesity, and difficult to visualize veins potentially affecting the surgically ill, inability to obtain peripheral intravenous (PIV) access may hinder the clinician's ability to avoid the use of central lines. With ultrasound gaining increased popularity for obtaining vascular access, we evaluated its utility in ultrasonagraphically placing PIV catheters for the purposes of either avoiding central venous access or removing central venous catheters.

The evolution of the Rhode Island trauma system: where do we stand?

The Rhode Island Trauma System today has been shown to demonstrate several positive attributes in the delivery of patient care; however, ongoing efforts need to continue in the realms of field and inter-facility communication, efficiency in inter-hospital transfer, and rehabilitation services. Through ongoing dialogue and the fundamental desire to improve, it remains our goal to provide patients the best care possible during one of the most stressful times of their lives.

Design, management, and critical evaluation of a surgical basic/clinical science curriculum: the role of an educational chief resident.

Objective: To demonstrate that a surgery "educational" chief resident can develop a resident-centered, evidence-based, surgical basic/clinical science curriculum that will improve American Board of Surgery In-Training Examination (ABSITE) scores.

Design: Retrospective cohort study.

Methods: Two curriculums were developed by 2 surgical "educational" chief residents (in their final year of training), for the academic years 2005-2006 and 2006-2007.

Coronary stenting during burn shock: diagnostic and treatment considerations.

Myocardial injury is known to occur in victims of both thermal and electrical burns. A variety of mechanisms have been ascribed to the pathogenesis of cardiac damage during burn shock. However, limited evidence exists that coronary artery thrombosis plays a frequent role.

Portal venous gas detected by computed tomography: is surgery imperative?

Background: Portal vein gas (PVG) has historically been associated with mortality rates of 75% or higher and mandatory abdominal exploration. The following study reassesses the clinical significance of gas in the portal venous system detected by computed tomography (CT) and reevaluates the need for surgical intervention in that setting.

Methods: We performed a retrospective chart review of 26 patients presenting with gas in the portal venous system as imaged by CT between August 1, 1993 and April 8, 2001.