Hospitals' adoption of targeted cognitive and functional status quality indicators for vulnerable elders.

Cognitive and functional impairments are leading predictors of poor outcomes in hospitalized older adults. This study reports adoption rates of 9 Assessing Care of Vulnerable Elders quality indicators in a sample of US hospitals (N = 128). Chief nursing officers were surveyed using a 6-point scale (no activity to full implementation) for each Assessing Care of Vulnerable Elders quality indicator.

Immunologic function in the elderly after injury--the neutrophil and innate immunity.

Background: Aging is associated with a decline in immune function. This may contribute to decreased ability of an elderly patient to mount an appropriate innate inflammatory response when injured. This study examined elderly trauma patients to determine whether there was a difference in neutrophil response to injury when compared with controls.

In harm's way: Moving the older trauma patient toward a better outcome.

This century will bring an explosion in the geriatric population aged 65 and older, with those over 80 the fastest growing group. Falls, vehicle collisions, burns, and abuse are traumatic events that our geriatric patients may be susceptible to and from which they may not recover. Primary care providers should enhance their understanding of the complex issues of geriatric trauma to facilitate prevention and to assist the patient's recovery to normal function, addressing barriers such as immobility, pain, malnutrition, and acute confusion.

Effects of early nightmares on the development of sleep disturbances in motor vehicle accident victims.

The present study prospectively examined the extent to which trauma-related nightmares affected the subsequent development of insomnia symptoms in 314 motor vehicle accident (MVA) victims. Participants were assessed in-hospital and at 2 weeks, 6 weeks, 3 months, and 1 year post-MVA. Hierarchical linear regression analyses showed that 6-week PTSD symptoms (PTSS) and 3-month nightmares, but not 2-week nightmares were positively associated with sleep onset and maintenance problems reported at 3-month post-MVA.

Autopsy data in the peer review process improves outcomes analysis.

Background: The value of autopsy findings has been questioned in peer review at mature trauma centers. We sought to determine the impact of autopsy data on the peer-review process.

Methods: This was a retrospective study.

Geriatric outcomes are improved by a geriatric trauma consultation service.

Background: Traumatic injuries in older patients are complex and have significant impact on the individual, their family, and trauma centers. We hypothesized that greater attention to the timely identification and comprehensive management of comorbid conditions would improve outcomes in the care of the older injured patient.

Methods: This was a prospective, descriptive study of all patients 65 years of age and older admitted to the trauma service.

Use of the Broselow tape may result in the underresuscitation of children.

Objectives: The purpose of this study was to determine the concordance of the Broselow tape with the measured heights and weights of a community-based population of children, especially in light of the increase in obesity in today's children.

Methods: The authors examined more than 7,500 children in a cross-sectional, descriptive study in two different cohorts of children to compare their actual weight with their predicted weight by a color-coded tape measure.

Results: In all patients, the percent agreement and kappa values of the Broselow color predicted by height versus the actual color by weight for the 2002A tape were 66.

Dollars and sense: attributing value to a level I trauma center in economic terms.

Background: Reliable, accurate, program-specific data for hospital product lines are often difficult to obtain. The purpose of this study was to determine the impact that trauma center status has on hospital net income when compared with other traditional hospital product lines and services.

Methods: Over a 3-year period, financial data were collected for 16 payor classes: 8 major payors for all injury diagnoses, in-patient and out-patient.

Fetal evaluation for transport by ultrasound performed by air medical teams: A case series.

The air medical team has limited options when evaluating the obstetrical patient and assessing fetal health during air transport to a high-risk obstetrical unit. Traditionally, physical examination and a Doppler stethoscope have been used to determine fetal heart rates and movement. However, with the advent of portable ultrasound technology, new information about the mother and child are available to the air medical crew.

System thinking in a personal context to improve eating behaviors.

People can create positive environments so that their chances of relapse to poor habits are reduced and their likelihood of success is increased. Continuous quality improvement (CQI) suggests that this can be accomplished by making systemwide changes and deemphasizing personal effort. This article provides a 7-step approach to system thinking in a personal context.

Delayed operative intervention in the management of traumatic descending thoracic aortic rupture.

Background: Outcomes may be improved by purposefully delaying surgical intervention of the traumatically ruptured descending thoracic aorta.

Methods: Fifty-seven patient records identified through the Trauma Registry of a level 1 trauma center between January 1993 and April 2002 were retrospectively analyzed between groups who underwent "clamp-and-sew" versus partial left heart bypass repair techniques and between emergent versus delayed repair.

Results: Thirty-two (56%) of 57 patients were male.

Central retinal artery occlusion by proxy: a cause for sudden blindness in an airline passenger.

The use of gas media in ophthalmologic procedures is relatively commonplace. Scleral buckle and pneumatic retinopexy procedures using air-gas mediums are a widely accepted treatment for retinal detachment. We present a patient who had a scleral buckle with pneumatic retinopexy performed and subsequently flew in a commercial airliner 2 wk later.

Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium.

Introduction: The study purpose was to evaluate tracheal intubating conditions and cardiovascular effects of rocuronium (roc) and vecuronium (vec) in the transport setting.

Methods: A prospective blinded study of adult patients requiring emergency rapid sequence oral tracheal intubation using direct laryngoscopy. Patients received equipotent doses of roc 1.

Intubated pediatric patients requiring transport: a review of patients, indications, and standards.

Introduction: We could not find any studies of nontertiary care facilities performing intubation for patients requiring transport to definitive pediatric care. The purpose of our study was to determine the current practices of pediatric airway management in the prehospital and transport environments.

Methods: A retrospective analysis of all patients younger than 16 years transported by our flight program during a 2-year period served as the population of interest.