Trauma Center Emergency Research Articles

A case report on the unusual facial injuries: Impalement injuries

Introduction: Impalement injuries are comparatively rarer in nature than other types of injuries. They mostly affect the extremities, whereas the face is rarely involved. They are defined as penetrating injuries, wherein a traumatic object gets impaled in the human body. Impalement injuries of the face present to the emergency. The approach and management of such injuries remain controversial and requires a multi-team approach. We report a case of an impalement injury of the face along with its successful management. Case Report: An interesting case of transorbital penetrating injury is presented. An 8-year-old male child presented in the emergency trauma centre with an alleged history of fall from the first floor of his house resulting in a penetrating injury by a roof tile 'Khaprail' to his face and skull. Conclusions: Impalement injuries to the face and skull require a prompt action, multi-team approach and urgent surgical intervention to prevent damage to salvageable vital tissues. A thorough knowledge of relevant surgical anatomy and a disciplined surgical hand is imperative for optimal results.

Rapid ethnographic assessment of the COVID-19 pandemic April 2020 ‘surge’ and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center

ObjectivesAssess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related...

Detailed information gain and therapeutic impact of whole body computed tomography supplementary to conventional radiological diagnostics in blunt trauma emergency treatment: a consecutive trauma centre evaluation

PurposeThe indication of whole body computed tomography (WBCT) in the emergency treatment of trauma is still under debate. We were interested in the detailed information gain obtained from WBCT following standardized conventional imaging (CI).MethodsProspective study including all emergency trauma centre patients examined by CI (focused assessment of sonography in trauma, chest and pelvic X-ray) followed by WBCT from 2011 to 2017. Radiology reports were compared per patient for defined body regions for number and severity of injuries (Abbreviated Injury Scale, AIS; Injury Severity Score, ISS), incidental findings and treatment consequences (Wilcoxon signed rank test, Spearman rho, Chi-square).Results1271 trauma patients (ISS 11.3) were included in this study. WBCT detected more injury findings than CI in the equivalent body regions (1.8 vs. 0.6; p < 0.001). In 44.4% of cases at least one finding was missed by CI alone. Compared to WBCT, injury severity of specified body regions was underestimated by CI on average by an AIS of 1.9 (p < 0.001). In 22.0% of cases injury severity increased by an AIS ≥ 2 following WBCT. In 16.8% of patients additional injury findings resulted in a change of treatment (number needed to profit, NNP = 6 patients): NNP decreased from 25 for patients with an ISS < 7 up to nearly 2 for patients with an ISS > 25 at final evaluation, thereby demonstrating a significant improvement in the NNP with increasing ISS (rho = 0.33, p < 0.001). Moreover, WBCT in 88.4% of patients identified ≥ 1 incidental finding (mean 3.4) vs. 28.9% by CI only (p < 0.001). Overall, WBCT had treatment consequences in 31.9% of cases (NNP = 3.1).ConclusionsThe application of WBCT in addition to CI in the emergency treatment of trauma had therapy consequences for almost every third patient. On the other hand, WBCT appeared not to be indicated (ISS < 8) in at least 2/5 of patients.

A validated predictive algorithm of post-traumatic stress course following emergency department admission after a traumatic stressor.

Annually, approximately 30 million patients are discharged from the emergency department (ED) after a traumatic event1. These patients are at substantial psychiatric risk, with approximately 10-20% developing one or more disorders, including anxiety, depression or post-traumatic stress disorder (PTSD)2-4. At present, no accurate method exists to predict the development of PTSD symptoms upon ED admission after trauma5. Accurate risk identification at the point of treatment by ED services is necessary to inform the targeted deployment of existing treatment6-9 to mitigate subsequent psychopathology in high-risk populations10,11. This work reports the development and validation of an algorithm for prediction of post-traumatic stress course over 12 months using two independently collected prospective cohorts of trauma survivors from two level 1 emergency trauma centers, which uses routinely collectible data from electronic medical records, along with brief clinical assessments of the patient's immediate stress reaction. Results demonstrate externally validated accuracy to discriminate PTSD risk with high precision. While the predictive algorithm yields useful reproducible results on two independent prospective cohorts of ED patients, future research should extend the generalizability to the broad, clinically heterogeneous ED population under conditions of routine medical care.

Construction of standardized and programmed multi-level medical rescue system: 26-year experience review and prospect of Tianjin Trauma Emergency Center

With the rapid development of modern society, high energy injury has greatly increase as compared with the past, and the number of trauma patients seeking medical treatments has risen year by year. Trauma emergency medicine has become the reflection of the service level and medical quality of medical institutions, as well as the hospital administrators' attention and concern to this discipline. This paper aims to elaborate the status and role of emergent medicine of trauma in the development of hospitals, to review the significant experience in the construction and reform of Tianjin Trauma Emergence Center, and put forward the prospect of future disciplines and center construction in combination with the practice.

Characteristics of interpersonal violence in adult victims at the Adult Emergency Trauma Centre (AETC) of Queen Elizabeth Central Hospital.

Globally, the burden of interpersonal violence and its significant impact on mortality, morbidity and disability makes it a major public health problem which necessitates intervention. This article examines characteristics of victims of interpersonal violence and violent events in Malawi. The focus is on a population that has been traditionally neglected in literature. Queen Elizabeth Central Hospital (QECH) maintains a trauma registry with data that is prospectively collected. Patients offered trauma care after interpersonal violence from May 2013 to May 2015 were evaluated. There were 1431 patients with violent events recorded at the Adult Emergency Trauma Centre (AETC) with a male predominance of 79.5%. The dominant age group was young adults between 25-29 years old (22%). Most attacks occurred during cold and dry season (46.9%) and most common location was on the road (37.2%). Alcohol use by victims was recorded in 10.5% of cases. Soft tissue injuries were the most common injuries sustained (74.1%). Most patients were treated as outpatients (80.9%). There were two deaths. At multivariate analysis, women had a lower risk of interpersonal violence as compared to men, (OR 0.82 [0.69-0.98]). Victims' use of alcohol was associated with increased risk of assault (OR 1.63 [1.27-2.10]). As compared to other places, odds of being assaulted were higher at home (OR 1.62 [1.27-2.06]) but lower at work (OR 0.68 [0.52-0.89) and on the road (OR 0.82 [0.65-1.03]). Odds of being assaulted were higher in the cold and dry season as compared to hot and dry season, (OR 1.26 [1.08-1.47]). Young males were most involved in interpersonal violence. Location of injury and seasonal variation were significant factors associated with interpersonal violence and most commonly sustained injuries were soft tissue injuries. These findings will help in identifying targeted interventions for interpersonal violence in Malawi and other low-and-middle-income countries (LMICs).

Construction and application of information platform for pre-hospital and in-hospital synergic treatment in trauma emergency center

In order to provide timely and effective treatment and reduce the rate of death and disability for trauma patients, the National Health Construction Commission issued a document to promote the construction of trauma centers and achieve centralized hospitalization for trauma patients. Pre-hospital first aid is the most important part of the modern emergency medical system, and it is especially important for the successful treatment of trauma patients. In order to achieve close coordination, efficient docking, emergency clinic advancement in the front yard, and improve the success rate of trauma patients, Nanchang Emergency Center proposed an integrated treatment mode for pre-hospital first aid and trauma emergency center, and developed a pre-hospital collaborative treatment information platform. The authors explore the application of the information platform in the integrated treatment mode of pre-hospital first aid and trauma emergency center and realize information sharing in the front yard of trauma patients, pre-hospital teleconsultation and seamless docking in the front yard, so as to provide a foundation for fast, efficient and full-coverage medical treatment system for trauma. Key words: Emergency medicine; Emergency medical services; Trauma emergency centers

A Tribute to N. Genell Lee

A Tribute to N. Genell Lee

TRIAGE AND EMERGENCY MEDICAL MANAGEMENT OF THE ACUTE RADIATION SYNDROME

Introduction: Medical personnel of the state Emergency Medical Services (EMS) will be the first element involved in providing assistance to victims of radiation incidents. Triage, initial diagnosis and further patient medical management will depend on their actions. In many radiation incidents, initial radiation triage and early diagnostics will be carried out in the emergency department (ED) or trauma center (TC). Extended triage, diagnosis of ARS and proper treatment will be continued in specialist centers. The aim: To present a model of patient medical management including initial triage and early diagnosis of ARS that can be carried out at the ED and TC. Material and methods: The initial medical procedures prepared by expert groups were presented. The choice of procedures was made in terms of the possibility of their application by the EMS teams in Poland. Particular attention was paid to the method of initial triage, based on the clinical condition and laboratory diagnostics. Results: Based on the material collected, the path of the initial medical procedure was presented. Variants of the radiation triage, interpretation of clinical parameters and results of laboratory tests are presented. The methods of initial treatment and the method of qualification for specialist treatment, and new methods of treating patients were also described. Conclusions: An adequate evaluation of radiation incidents, determining the absorbed dose of ionising radiation and ARS, as well as initial triage seem to be crucial skills of the EMS workers.

Analysis on key points for construction of trauma emergency center of Jiangxi Province

Trauma is the leading cause of death for people under 40 years old in the world. At present, the rescue and treatment system of trauma patients in China is not yet well established, and the mortality of trauma patients is higher than those in the developed countries. Improving the treatment system is the key to reducing the trauma mortality. In order to innovate the service mode of trauma first aid, further promote the establishment of regional trauma first aid system, improve the ability of trauma treatment, reduce the mortality and disability rate of trauma patients in Jiangxi Province, recently Health Commission of Jiangxi Province and the First Affiliated Hospital of Nanchang University have reached a consensus on the establishment of Jiangxi trauma first aid center. In order to provide reference for the construction of trauma treatment system, the author analyzes the following aspects including functional positioning, basic requirements, organization management, and evaluation of core indicators. Key words: First aid; Wounds and injuries; Expert consensus

282 Implementation of the "Pause” in a Level 1 Adult Emergency Department and Trauma Center

282 Implementation of the "Pause” in a Level 1 Adult Emergency Department and Trauma Center

Relationship between serum apolipoprotein A-1 level and severity of trauma in patients with trauma

Objective To explore the relationship between serum apolipoprotein A-1 (apoA-1) level and severity of trauma in patients with trauma. Methods Data of 138 trauma patients admitted by EICU from October 2017 to April 2018 in the Acute Trauma Emergency Center of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were collected retrospectively. Gender, age, admission time, trauma mechanism, and injury severity score (ISS) were recorded, and serum apoA-1 level was measured and recorded within 24 h after injury. Patients were divided into three groups according to the ISS score: the light injury group (47 cases, ISS < 16), the serious injury group (45 cases, 16 ≤ISS < 25), and the critical injury group (46 cases, ISS ≥ 25). The correlation between serum apoA-1 level and ISS score was verified by adopting Pearson correlation analyses, and the differences in serum lipoprotein A level within 24 h after injury were compared among 3 groups by one-way ANOVA. Results Serum apoA-1 level was negatively correlated with ISS score (r=-0.307, P<0.01). There was significant difference in serum apoA-1 level between different trauma groups (F=8.864, P<0.01), among which the difference between the light injury group and critical injury group was the largest (P<0.01). The level of serum apoA-1 in the critical injury group was lower than that in the light injury group (P<0.01) and the serious injury group (P=0.038), while the level of serum apoA-1 in the serious injury group was lower than that in the light injury group (P=0.040). Conclusions Early serum apoA-1 level in patients with trauma is closely related to the severity of trauma and may be a better indicator to evaluate the prognosis of patients with trauma. Key words: Trauma; Apolipoprotein A-1; Prognosis; Inflammation; Stress

Alcohol-related trauma reinjury prevention with hospital-based screening in adult populations: An Eastern Association for the Surgery of Trauma evidence-based systematic review.

Unaddressed alcohol use among injured patients may result in recurrent injury or death. Many trauma centers incorporate alcohol screening, brief intervention, and referral to treatment for injured patients with alcohol use disorders, but systematic reviews evaluating the impact of these interventions are lacking. An evidence-based systematic review was performed to answer the following population, intervention, comparator, outcomes question: Among adult patients presenting for acute injury, should emergency department, trauma center, or hospital-based alcohol screening with brief intervention and/or referral to treatment be instituted compared with usual care to prevent or decrease reinjury, hospital readmission, alcohol-related offenses, and/or alcohol consumption? A librarian-initiated query of PubMed, MEDLINE, and the Cochrane Library was performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of the evidence and create recommendations. The study was registered with PROSPERO (registration number CRD42019122333). Eleven studies met criteria for inclusion, with a total of 1,897 patients who underwent hospital-based alcohol screening, brief intervention, and/or referral to treatment for appropriate patients. There was a relative paucity of data, and studies varied considerably in terms of design, interventions, and outcomes of interest. Overall evidence was assessed as low quality, but a large effect size of intervention was present. In adult trauma patients, we conditionally recommend emergency department, trauma center, or hospital-based alcohol screening with brief intervention and referral to treatment for appropriate patients in order to reduce alcohol-related reinjury. Systematic review, Level III.

Health Systems Have a Role in Preventing Firearm Injury.

Every day in the United States, health professionals confront the effects of firearm injury. In emergency rooms, trauma centers, ambulatory offices, and acute care and rehabilitation facilities, health professionals and the health systems they work within attempt to heal the wounds that firearms can inflict on individuals and their families. Thus, hospitals and health systems are in a position to grasp the scope of the issue and find opportunities to prevent firearm injury and death. In 2016 and 2017, the physicians and nurses at Kaiser Permanente treated more than 3,400 gunshot victims. These patients—from a single health system among the hundreds that operate across the United States—are a sobering reminder of the toll of firearm injury. Firearm injury—including other-directed, self-directed, and unintentional injury and death—is a broad-based public health issue. In 2016, more than 38,000 people were killed by firearms.1 In the same year, half of those who died by suicide used a firearm, and three quarters of homicides involved a firearm.1 Firearm death is the third leading cause of death for children under age 17 in the United States. A social network analysis by Kalesan and colleagues2 showed that almost everyone in the United States, at some point, will know someone injured or killed by a firearm. The nature of the injury varies—homicide is the more likely cause of a firearm death in an urban area, whereas suicide is more likely in a rural area—but every community in every geographic region and every socioeconomic stratum is … Address correspondence to: Questions or comments should be directed to Melissa French at mfrench{at}nas.edu.

Short-term outcomes of rod-shaped glass bone graft for treatment of tibial plateau fracture

Objective To analyze the short-term outcomes of rod-shaped glass bone graft for the treatment of tibial plateau fracture. Methods From January 2019 to February 2019, 4 patients with tibial plateau fracture underwent minimally invasive reduction and new glass bone graft at Trauma Emergency Center, The Third Hospital of Hebei Medical University. They were 2 men and 2 women, aged from 31 to 67 years (average, 42 years). The fractures happened at 3 left sides and one right side. According to Schanzker's classification, 3 cases were type Ⅱ and one case was type Ⅲ. According to Zhang's classification for tibial plateau fractures, they were all type Ⅰ. The reduction was carried out under general anesthesia by a Zhang's traction device and a self-made rod. A rod-shaped glass bone graft of appropriate size was implanted along the bone tunnel. The plate was implanted through small incisions after fluoroscopy results were satisfactory. Intraoperative arthroscopic examination was used to assess fracture displacement before wound closure. The operation time, incision length, fluoroscopic frequency for insertion of guide needle, intraoperative blood loss, and short-term postoperative complications were recorded for each patient. Results The operation time for the patients averaged 37.5 min, the total length of all incisions 7.0 cm, the fluoroscopy required for insertion of guide needle 8.8 times, and the intraoperative blood loss 40.0 ml. All incisions were healed by the first intention. Postoperative intermuscular thrombosis occurred in 2 cases. No postoperative infection or related complications happened. Conclusion Rod-shaped glass bone graft can lead to positive short-term outcomes for tibial plateau fractures, but a more reliable conclusion necessitates further clinical trials with a large sample size and long-term follow-up. Key words: Knee joint; Surgical procedures, minimally invasive; Bone graft; Tibial plateau fracture; Glass bone

Health Systems Have a Role in Preventing Firearm Injury

Every day in the United States, health professionals confront the effects of firearm injury. In emergency rooms, trauma centers, ambulatory offices, and acute care and rehabilitation facilities, health professionals and the health systems they work within attempt to heal the wounds that firearms can inflict on individuals and their families. Thus, hospitals and health systems are in a position to grasp the scope of the issue and find opportunities to prevent firearm injury and death. In 2016 and 2017, the physicians and nurses at Kaiser Permanente treated more than 3,400 gunshot victims. These patients—from a single health system among the hundreds that operate across the United States—are a sobering reminder of the toll of firearm injury. Firearm injury—including other-directed, self-directed, and unintentional injury and death—is a broad-based public health issue. In 2016, more than 38,000 people were killed by firearms.1 In the same year, half of those who died by suicide used a firearm, and three quarters of homicides involved a firearm.1 Firearm death is the third leading cause of death for children under age 17 in the United States. A social network analysis by Kalesan and colleagues2 showed that almost everyone in the United States, at some point, will know someone injured or killed by a firearm. The nature of the injury varies—homicide is the more likely cause of a firearm death in an urban area, whereas suicide is more likely in a rural area—but every community in every geographic region and every socioeconomic stratum is … Address correspondence to: Questions or comments should be directed to Melissa French at mfrench{at}nas.edu.

Injury-based Geographic Access to Trauma Centers.

Previous studies examining access to trauma care use patient residence as a proxy for location and need for services, which could result in a flawed understanding of access to trauma centers. The objective of this study was to examine the geographic access of the U.S. population to trauma centers based on trauma incident locations. We conducted a cross-sectional study using 9-1-1 emergency medical services activations associated with traumatic injury from the 2014 National Emergency Medical Services Information System and trauma centers participating in the 2014 American Hospital Association Annual Survey. The measures included the percentage of trauma incidents that could reach a trauma center within 60 minutes by ground ambulance, capacity-to-demand ratio for each trauma center, and overall trauma care accessibility ratio for each U.S. zip code. A total of 92.9% of all trauma incidents could be transported to an existing trauma center within 60 minutes by ground ambulance, and 85.3% could be transported to a Level I or II trauma center within this time frame in the 32 study states. While 94.7% of trauma incidents in the Northeast area could be transported to a Level I or II trauma center within a 60-minute driving time, the capacity-to-demand ratios of trauma centers in this region were low, indicating high utilization of those trauma center resources. By using the accessibility measure, we found that some Midwestern and Southern states had higher amounts of accessible trauma center resources relative to the number of injuries than Northeastern states. These findings suggest that greater access to trauma care and significant variations can be observed throughout the 32 study states when using trauma incident location rather than patient residence to calculate access to trauma care. The proposed capacity-to-demand ratio and accessibility ratio can be applied to many other needs assessments in health care.

Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients

Image 1Contribution to Emergency Nursing Practice: •Alcohol and substance use is a significant factor in adolescent trauma. By identifying patients at-risk for substance-use disorders, providers can provide early interventions to support this vulnerable population. •The American College of Surgeons Committee on Trauma (ACS-COT) requires Level I and II trauma centers to screen high-risk users to maintain center accreditation. Several screening tools have been investigated, including both biochemical testing and questionnaires, but it remains unclear which modality most effectively identifies at-risk adolescent trauma patients. •Providers in emergency departments and trauma centers are well positioned to screen for high-risk behaviors such as alcohol and substance use, as studies on screening and early interventions in the adolescent trauma population have demonstrated reduction in recurrent injury and readmission rates. •Although no screen identifies all at-risk adolescents, evidence supports implementation of an evidence-based, developmentally appropriate universal screening protocol consisting of biochemical screening in conjunction with self-report.

The Role of Thromboelastography Testing in the Emergency Medicine, Trauma Center, and Critical Care Environments

Thromboelastography (TEG) has been gaining attention for its potential use in a variety of disease of states to guide therapies and determine prognosis. This review will explore recent research specifically regarding the use of thromboelastography in the emergency, trauma, and critical care clinical environments. Thromboelastography has its drawbacks. TEG has wide operator and machine variability. Known coagulopathic states may exhibit normal viscoelastic results, indicating inconsistent results. Thromboelastography has shown to decrease transfusion of blood products in traumatic hemorrhage. In sepsis, both hypercoagulable and hypocoagulable states occur. Patients with certain neurological conditions may have disparate results on viscoelastic testing. Patients with intracranial bleeding and hematoma expansion were found to be hypocoagulopathic, whereas acute ischemic stroke patients tend to have hypercoagulopathic results. The bottom line is that thromboelastography requires further study before standard utilization for emergency and critical care departments.

Methodological Considerations for Research With Black Male Victims of Violent Injury in an Urban Trauma Unit.

There is a body of research over the last three decades that has focused on the etiology of violence among victims of violent injury. This body of literature indicates that Black men are disproportionately represented among victims of violent injury seen in emergency departments and trauma centers across the country. Despite the disproportionate number of low-income young Black men treated for violent injury in urban trauma units and the growing body of literature accompanying it, little is known about the unique methodological challenges violent injury researchers face when conducting research on this vulnerable population in a clinical setting. This article describes the unique and often nuanced methodological difficulties a research team encountered while conducting a longitudinal qualitative study on risk factors for repeat violent injury among low-income young Black male victims of violent injury treated at a Level II trauma center in the Eastern United States. Four methodological challenges are identified: (a) the identification and screening of participants, (b) recruitment and interviewing, (c) understanding hospital culture, policies, and procedures, and (d) retention and attrition of sample. Recommendations to overcome these challenges are offered.