Hospital Admissions For Trauma Research Articles

Pancreatic and Duodenal Injuries: Experience at A Single Trauma Centre

Background: Pancreatic and duodenal injuries are uncommon due to relative protection by their posterior anatomical position and have an incidence of less than 1% of all hospital admissions for trauma. Auckland City Hospital is a tertiary referral hospital in New Zealand with Trauma and Hepatopancreatobiliary units and admits approximately 384 patients with major trauma per year, predominantly from blunt mechanisms. This study is used to assess the incidence, diagnosis and clinical management of pancreatic and duodenal injuries in trauma patients at a single trauma centre. Method: A retrospective study was undertaken using data from a prospectively collected trauma registry. Inpatient notes including all patients admitted from 2007 to 2020 were reviewed. Pancreatic and duodenal injuries were graded using the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) grading system. Investigations including radiology and biochemistry and clinical management were noted. Results: A total of 45 trauma patients admitted to Auckland City Hospital had sustained pancreatic or duodenal injuries. Six patients had combined pancreaticoduodenal injuries, 16 had duodenal and 23 had pancreatic injuries. Grade I organ injuries were the most common in pancreatic (19/29) and duodenal injuries (9/22). Majority of patients underwent laparotomy (33/45) for associated haemodynamic instability. All organ specific indications for surgery occurred in Grade II and higher injuries. 10/45 patients were managed non-operatively, of which the majority had Grade I or II organ injuries (9/45). 3/45 patients died. Conclusion: The incidence of pancreaticoduodenal injuries is rare (45 patients in 13 years) and in keeping with trauma literature. In our series, haemodynamically stable patients with Grade I - II pancreatic and Grade I - II (non-laceration type) duodenal injuries did not require operative management. Endoscopic pancreatic stenting may facilitate selective non-operative management in some patients with pancreatic injury or complications.

CO16 Persistent Opioid Use after Hospital Admissions for Trauma in New Zealand

CO16 Persistent Opioid Use after Hospital Admissions for Trauma in New Zealand

Mortality after hospital admission for trauma in Norway: A retrospective observational national cohort study

BackgroundNational quality data for trauma care in Norway have not previously been reported. We have therefore assessed crude and risk-adjusted 30-day mortality in trauma cases after primary hospital admission on national and regional levels for 36 acute care hospitals and four regional trauma centres. MethodsAll patients in the Norwegian Trauma Registry in 2015–2018 were included. Crude and risk-adjusted 30-day mortality was assessed for the total cohort and for severe injuries (Injury Severity Score ≥16), and individual and combined effects of health region, hospital level, and hospital size were studied. Results28,415 trauma cases were included. Crude mortality was 3.1% for the total cohort and 14.5% for severe injuries, with no statistically significant difference between regions. Risk-adjusted survival was lower in acute care hospitals than in trauma centres (0.48 fewer excess survivors per 100 patients, P<0.0001), amongst severely injured patients in the Northern health region (4.80 fewer excess survivors per 100 patients, P = 0.004), and in hospitals with <100 trauma admissions per year (0.65 fewer excess survivors than in hospitals with ≥100 admissions, P = 0.01). However, the only statistically significant effects in a multivariable logistic case mix-adjusted descriptive model were hospital level and health region. Case-mix adjusted odds ratio for survival for severely injured patients directly admitted to a trauma centre vs. an acute care hospital was 2.04 (95% CI 1.04–4.00, P = 0.04), and if admitted in the Northern health region vs. all other health regions was 0.47 (95% CI 0.27–0.84, P = 0.01). The proportion of cases admitted directly to the regional trauma centre in the sparsely populated Northern health region was half of that in the other regions (18.4% vs. 37.6%, P<0.0001). ConclusionDifferences in risk-adjusted survival for severe injuries can to a large extent be attributed to whether patients are directly admitted to a trauma centre. This should have implications for planning of transport capacity in remote areas.

Impact of an opioid use disorder consult service on hospitalized trauma patients with opioid use disorder.

Opioid use disorder (OUD) is common in the hospitalized trauma population, being a comorbid diagnosis in approximately 1% of operative trauma cases. The impact of an addiction consult service in this population has been less well studied but may lead to increased provision of evidence-based OUD treatment and improved postdischarge outcomes. One hundred thirteen patients with an International Classification of Diseases diagnosis of OUD who were admitted to the trauma service at a single academic hospital between January 2020 to December 2021 were included in a retrospective chart review. Wilcoxon rank-sum tests were used to evaluate differences between patients who received an OUD consult and those who did not. Regression analysis was used to assess differences in postdischarge acute care utilization, attendance of follow-up appointments, initiation of and discharge on medication for opioid use disorder (MOUD), naloxone prescribing at discharge, and length of stay (LOS) between the consult and no-consult groups. Eighty-one patients in the study population received a consult and 32 did not. Patients in the consult group were more likely to have started MOUD during their admission (odds ratio [OR], 2.09; p < 0.001), be discharged with naloxone (OR, 1.89; p < 0.001), have a plan in place for continued OUD treatment at discharge (OR, 1.43; p < 0.001), and attend scheduled follow-up appointments with the trauma team (OR, 1.76; p = 0.02). Differences in acute care utilization and LOS between the two groups were not statistically significant. An OUD consult service can provide benefit to hospitalized trauma patients by increasing likelihood of starting MOUD, of discharging with MOUD and naloxone, and of attending trauma follow-up appointments without increasing LOS or acute care utilization. Thus, addiction consult service interventions during hospital admissions for trauma may serve to facilitate both evidence-based OUD care and posthospitalization trauma care. Therapeutic/Care Management; Level IV.

The COVID-19 pandemic reduced the trauma incidence and modified its pattern in Al-Ain City, United Arab Emirates

AimWe aimed to study the impact of the COVID-19 pandemic on the pattern of injury and outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates, to use this information in the preparedness for future pandemics.MethodsWe retrospectively compared the trauma registry data of all hospitalised trauma patients, who were treated at the two main trauma centres in Al-Ain City (Al-Ain Hospital and Tawam Hospital); those who were treated over 1 year before the pandemic (n = 2002) and those who were treated at the first year of the COVID-19 pandemic (n = 1468).ResultsThere was a 26.7% reduction in the overall incidence of trauma admissions in the COVID-19 pandemic period. The mechanism of injury significantly differed between the two periods (p < 0.0001, Fisher’s exact test). There was an absolute increase in the number of injuries, due to machinery and falling objects during the pandemic (39.7% and 54.1% respectively, p < 0.001). In contrast, road traffic collisions and falls were reduced by 33.5% and 31.3%, respectively. Location significantly differed between the two periods (p < 0.0001, Fisher’s exact test). There was an absolute increase of 18.4% in workplace injuries and a reduction of 39.3% in home injuries over the study period. In addition, we observed relatively more workplace injuries and fewer home injuries during the pandemic (11.3% and 42.8% compared with 7.1% and 52.4%, respectively). Mortality was similar between the two periods (1.8% compared with 1.2%, p = 0.16, Fisher’s exact test).ConclusionsThe COVID-19 pandemic has modified the trauma risk exposure in our population. It reduced trauma hospital admissions by around 27%. Work-related injuries, including falling objects and machinery injuries, were relatively higher during the pandemic. Prevention of work-related injuries should be an important component of preparedness for future pandemics.

261. Outcomes in patients with vertebral injury after cervical spine trauma

<h3>BACKGROUND CONTEXT</h3> Vertebral artery injury (VAI) occurs in almost 1% of all blunt trauma hospital admissions. No large study has been conducted investigating outcomes of VAI in blunt cervical trauma. <h3>PURPOSE</h3> The objectives of this study were to evaluate 1-year outcomes in patients with blunt cervical spine trauma with vertebral artery injuries. <h3>STUDY DESIGN/SETTING</h3> Data from the National Trauma Data Bank (NTDB) in 2016 was analyzed. <h3>PATIENT SAMPLE</h3> Adult patients with cervical vertebral, ligamentous, or neurological trauma were included in the study. Patients who died within 3 days of admission were excluded. <h3>OUTCOME MEASURES</h3> Response variables collected included development of adverse events (DVT/PE, myocardial infarction (MI), stroke, hemorrhage, or neurological deficit) length of stay (LOS), intensive care unit (ICU) LOS, and unplanned ICU admission or surgical procedure. <h3>METHODS</h3> Demographic information (age, sex, race), injury specific information (mechanism, severity), patient health information, and a variable indicating the presence of vertebral artery injury were collected as explanatory variables. Multivariable regression was used to calculate the risk-adjusted effect of vertebral artery injury on the presence of adverse events and unplanned events as well as its relationship with LOS and ICU LOS. <h3>RESULTS</h3> A total of 64,662 patients with cervical trauma were reviewed, of which 2,310 had VAI. Of the patients with VAI, the 82 (3.6%) patients had a MI, 80 (3.5%) had a PE/DVT, 76 (3.3%) had a stroke, 36 (1.6%) had neurologic injury, and 94 (4.1%) had an unplanned operative procedure or ICU admission. After risk-adjustment, VAI was associated with an increased LOS and ICU LOS (p<0.001), as well as an increased risk of MI, PE/DVT, stroke, and neurologic injury (p<0.001). <h3>CONCLUSIONS</h3> Vertebral artery injury in cervical trauma leads to increase chance of adverse events and length of stay in the ICU and in the hospital. Trauma providers should be aware of these increased risks when treating patients with VAI in cervical trauma. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Trauma Recidivism in an Aging Population: Who Is Most at Risk?

Repeated episodes of trauma, particularly in older adults, result in increased morbidity and mortality. This study investigates trauma recidivism in our adult population to identify which patients in our region are more likely to become recidivists. This 4 year retrospective study (2013 to 2017) examines all patients 18 years of age or older with multiple hospital admissions for trauma, comparing patients ages 65 and older (older adults) to those ages 18 to 64 (younger adults). Exclusion criteria consisted of those younger than 18 and/or had a home zip code outside of the study region. Data included admission demographics, injury characteristics and other clinical metrics. There were 240 younger adult and 182 older adult trauma recidivists included. In total, 4% of all patients were recidivists with significantly higher rates of recidivism among older adults (OR: 1.94 [1.59-2.36], p <0.001). Older adult recidivists were more likely to be female (OR: 4.28 [2.82-6.51], p <0.001) and suffer blunt trauma secondary to a fall (OR: 5.36 [3.91-7.35], p <0.001). Trauma recidivism in older adults also correlated with a higher Injury Severity Score, longer length of stay and an increased proportion of patients requiring to be discharged home with organizational help or to a rehabilitation facility. Trauma can be recurrent and associated with poor health outcomes, particularly in older adults. Recidivists in the studied region were significantly older with the most at-risk population consisting of females suffering blunt injury secondary to a fall. Improved prevention strategies are needed for this population.

Persistent opioid use and opioid-related harm after hospital admissions for surgery and trauma in New Zealand: a population-based cohort study

IntroductionOpioid use has increased globally for the management of chronic non-cancer-related pain. There are concerns regarding the misuse of opioids leading to persistent opioid use and subsequent hospitalisation and deaths...

The Impact of the COVID-19 Pandemic on Hospital Admissions for Trauma and Acute Care Surgery

The Impact of the COVID-19 Pandemic on Hospital Admissions for Trauma and Acute Care Surgery

Financial Risk Protection and Hospital Admission for Trauma in Cameroon: An Analysis of the Cameroon National Trauma Registry.

Half of the global population is at risk for catastrophic health expenditure (CHE) in the event that they require surgery. Universal health coverage fundamentally requires protection from CHE, particularly in low- and middle-income countries (LMICs). Financial risk protection reports in LMICs covering surgical care are limited. We explored the relationship between financial risk protection and hospital admission among injured patients in Cameroon to understand the role of health insurance in addressing unmet need for surgery in LMICs. The Cameroon National Trauma Registry, a database of all injured patients presenting to the emergency departments (ED) of three Cameroonian hospitals, was retrospectively reviewed between 2015 and 2017. Multivariate regression analysis identified predictors of hospital admission after injury and of patient report of cost inhibiting their care. Of the 7603 injured patients, 95.7% paid out-of-pocket to finance ED care. Less than two percent (1.42%) utilized private insurance, and more than half (54.7%) reported that cost inhibited their care. In multivariate analysis, private insurance coverage was a predictor of hospital admission (OR 2.17, 95% CI: 1.26, 3.74) and decreased likelihood of cost inhibiting care (OR 0.34, 95% CI: 0.20, 0.60) when compared to individuals paying out-of-pocket. The prevalence of out-of-pocket spending among injured patients in Cameroon highlights the need for financial risk protection that encompasses surgical care. Patients with private insurance were more likely to be admitted to the hospital, and less likely to report that cost inhibited care, supporting private health insurance as a potential financing strategy.

Trauma-related mortality of patients with severe psychiatric disorders: population-based study from the French national hospital database.

Most research on mortality in people with severe psychiatric disorders has focused on natural causes of death. Little is known about trauma-related mortality, although bipolar disorder and schizophrenia have been associated with increased risk of self-administered injury and road accidents. To determine if 30-day in-patient mortality from traumatic injury was increased in people with bipolar disorder and schizophrenia compared with those without psychiatric disorders. A French national 2016 database of 144 058 hospital admissions for trauma was explored. Patients with bipolar disorder and schizophrenia were selected and matched with mentally healthy controls in a 1:3 ratio according to age, gender, social deprivation and region of residence. We collected the following data: sociodemographic characteristics, comorbidities, trauma severity characteristics and trauma circumstances. Study outcome was 30-day in-patient mortality. The study included 1059 people with bipolar disorder, 1575 people with schizophrenia and their respective controls (n = 3177 and n = 4725). The 30-day mortality was 5.7% in bipolar disorder, 5.1% in schizophrenia and 3.3 and 3.8% in the controls, respectively. Only bipolar disorder was associated with increased mortality in univariate analyses. This association remained significant after adjustment for sociodemographic characteristics and comorbidities but not after adjustment for trauma severity. Self-administered injuries were associated with increased mortality independent of the presence of a psychiatric diagnosis. Patients with bipolar disorder are at higher risk of 30-day mortality, probably through increased trauma severity. A self-administered injury is predictive of a poor survival prognosis regardless of psychiatric diagnosis.

Autobiographical memory and structural brain changes in chronic phase TBI

Traumatic brain injury (TBI) is associated with a range of neuropsychological deficits, including attention, memory, and executive functioning attributable to diffuse axonal injury (DAI) with accompanying focal frontal and temporal damage. Although the memory deficit of TBI has been well characterized with laboratory tests, comparatively little research has examined retrograde autobiographical memory (AM) at the chronic phase of TBI, with no prior studies of unselected patients drawn directly from hospital admissions for trauma. Moreover, little is known about the effects of TBI on canonical episodic and non-episodic (e.g., semantic) AM processes. In the present study, we assessed the effects of chronic-phase TBI on AM in patients with focal and DAI spanning the range of TBI severity. Patients and socioeconomic- and age-matched controls were administered the Autobiographical Interview (AI) (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002) a widely used method for dissociating episodic and semantic elements of AM, along with tests of neuropsychological and functional outcome. Measures of episodic and non-episodic AM were compared with regional brain volumes derived from high-resolution structural magnetic resonance imaging (MRI). Severe TBI (but not mild or moderate TBI) was associated with reduced recall of episodic autobiographical details and increased recall of non-episodic details relative to healthy comparison participants. There were no significant associations between AM performance and neuropsychological or functional outcome measures. Within the full TBI sample, autobiographical episodic memory was associated with reduced volume distributed across temporal, parietal, and prefrontal regions considered to be part of the brain's AM network. These results suggest that TBI-related distributed volume loss affects episodic autobiographical recollection.

Effect of patient safety incident review andreflection in an extended morbidity andmortality meeting.

We modified the departmental mortality and morbidity (M&M) meetings to evaluate whether patient safety incident review as a part of this meeting was associated with reduced patient safety incidents. A pilot programme of peer review of patient safety incidents (PSI) supported by education relevant to that event and follow-on action plan was introduced as a part of an extended morbidity and mortality meeting in a university hospital orthopaedic department. The pilot programme was conducted over six months (January 2012-June 2012). This programme involved junior and senior doctors including consultants although multidisciplinary groups were invited to attend. We investigated PSI rate/1000 hospital admissions for trauma and elective surgery, which were collected prospectively and independently between Jan 2011 to June 2013. We noted if the incident was caused by a medical or a nursing error and compared PSI rates. Rates of PSI (33/1000) were 7.8 times higher in trauma cases (80.2/1000) than in elective admissions (11.2/1000). There was 18% reduction in trauma and 27% reduction in planned elective admissions. The rate increased after the pilot programme finished but there was still a 7% reduction compared to the pre-pilot period. This study found a significant reduction in the PSI rate for medical error but no change in the rate of nursing error. This continuous reflection, education and action process, where safety events are reviewed as a part of the extended morbidity and mortality meeting, is associated with reduction of patient safety incidents. We recommend that PSI reflection should be introduced in Mortality and Morbidity meetings with mandated attendance of the entire multidisciplinary health care team.

Impact of high ambient temperature on unintentional injuries in high-income countries: a narrative systematic literature review

ObjectivesGiven the likelihood of increased hot weather due to climate change, it is crucial to have prevention measures in place to reduce the health burden of high temperatures and heat...

Fall Prevention for Inpatient Oncology Using Lean and Rapid Improvement Event Techniques

The objective of this project was to reduce patient falls and falls with injury on three oncology divisions at a large urban teaching hospital. By standardizing assessment, intervention, and post-fall investigation processes the goal was to decrease patient falls and falls with injury rate by 50% and 30%, respectively. Preventing patients from being injured due to a fall during their hospitalization has been a concern in healthcare for many years. Organizations around the world such as Institute of Medicine, The Joint Commission, National Institute for Health and Clinical Excellence, National Australian Patient Safety Foundation, and the World Health Organization have been conducting research and publishing guidelines to identify evidence based interventions for fall prevention (Ulrich et al., 2008, Di Pilla, 2010). Falls are the most common cause of non-fatal injury and hospital admission for trauma. Death rates due to falls have risen sharply over the past decade due to aging of the population. A Rapid Improvement Event (RIE) technique was selected to implement the fall prevention initiative because it aligned with the hospital's lean transformation initiative. There was coordination with other departmental staff (physical and occupational therapy, pharmacy, physicians, information systems, low bed equipment vendor, and clinical operations) to achieve multidisciplinary input. A 22% decrease in total fall rate and a 37% decrease in falls with injury rate were achieved in the 16-month post-intervention period. Although a 22% decrease in total falls did not meet the goal of 50% decrease, the total falls with injury decrease of 37% did exceed the goal of 30%. Falls are a multi-faceted, complex problem that needs constant vigilance and continuous improvement to sustain patient safety. Anticipating physiologic changes in patients' conditions and implementing interventions before the fall is critical to fall prevention. While well-validated screening tools performed thoroughly and accurately can help hospital staff identify patient specific fall risk factors, risk assessment alone does not prevent falls. If the prevention of patient falls is identified as important by leadership and staff at the division level and all are invested in achieving established goals, success can be achieved and sustained. Case study, falls, hospital, human factors, organizational transformation, patients.

Measure, Promote, and Reward Mobility to Prevent Falls in Older Patients

THE ABILITY TO MAINTAIN AN UPRIGHT POSTURE AND walk are crucial to human survival. Until the development and dissemination of mobility assistance devices over the last few centuries, once a person lost these abilities, death often followed. Movement and upright posture are also important in protecting the integrity of organ systems and body functions such as skin, coagulation homeostasis, and cardiovascular fitness. Humans have developed considerable redundancy to sustain movement while either standing upright or sitting in a mobility assistance device like a wheelchair. Injury to one part of the neuromusculoskeletal system is compensated by recruiting other parts of the body to preserve upward mobility. However, with increasing age and injury, maintaining upright posture and movement becomes increasingly difficult. Falls are a manifestation of this phenomenon, serving as identifiers of other geriatric syndromes such as frailty and polypharmacy. In the past decade, the prevention of falls, particularly involving older institutionalized patients, has become a focus for practitioners, researchers, policy makers, and accreditors. Falls represent a leading cause of hospital admissions for trauma and deaths in older adults. Furthermore, 1 in 5 inpatients falls at least once during a hospitalization, and these falls can result in injuries, increased lengths of stay, malpractice lawsuits, and considerable incremental costs. As part of its overall strategy to align quality of care with financial incentives, the Centers for Medicare & Medicaid Services (CMS) announced on October 1, 2008, that falls would be listed as a “never-event” condition that would result in nonpayment for any related consequences that occurred as a result of a fall. However, systematic reviews estimate that at best, only about 20% of falls in institutional settings can be prevented. This difficulty perhaps became a primary reason falls were reclassified as “serious reportable events” in 2011. Unlike functional decline and delirium, falls are discrete events that seem easy to count. Accordingly, fall rates are increasingly being used to signify the quality of care delivered by hospitals, especially for older patients. In the short run, the easiest way to prevent falls is to reduce the chance they occur by limiting patient movement and activity. Manufacturers have responded by developing new devices that inhibit free movement. Indeed, the preoccupation with preventing falls may have led at times to active discouragement of mobilization.

Analysis of the cases of trauma and suicide attempts serviced by University General Hospital ‘Tsaritsa Yoanna—ISUL’, Sofia over 1 year period

AimTo estimate the rate of hospital admissions for trauma and burns due to external causes (ICD-10) for a 1 year period in comparison with the overall number of admissions in...

SIG 8 Perspectives Vol. 12, No. 1, December 2011

SIG 8 Perspectives Vol. 12, No. 1, December 2011

Association between Alcohol Screening Results and Hospitalizations for Trauma in Veterans Affairs Outpatients

Background: Alcohol consumption is a risk factor for traumatic injury, but it is unknown whether responses to alcohol screening questionnaires administered routinely in primary care are associated with subsequent hospitalization for traumatic injury. Objective: We evaluated the association between alcohol screening scores and the risk for subsequent hospitalizations for trauma among Veterans Affairs (VA) general medicine patients. Method: This study included VA outpatients (n = 32,623) at seven sites who returned mailed surveys (1997–1999). Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores grouped patients into six drinking categories representing nondrinkers, screen-negative drinkers, and drinkers who screened positive for mild, moderate, severe, and very severe alcohol misuse (scores 0, 1–3, 4–5, 6–7, 8–9, 10–12, respectively). VA administrative and Medicare data identified primary discharge diagnoses for trauma. Cox proportional hazard models were used to estimate the risk of trauma-related hospitalization for each drinking group adjusted for demographics, smoking, and comorbidity. Results: Compared with screen-negative drinkers, patients with severe and very severe alcohol misuse (AUDIT-C 8–9 and ≥10) were at significantly increased risk for trauma-related hospitalization over the follow-up period (adjusted hazard ratios AUDIT-C: 8–9 2.06, 95% confidence interval (CI) 1.31– 3.24 and AUDIT-C≥10 2.13, 95% CI 1.32–3.42). Conclusions: Patients with severe and very severe alcohol misuse had a twofold increased risk of hospital admission for trauma compared to drinkers without alcohol misuse. Scientific Significance: Alcohol screening scores could be used to provide feedback to patients regarding risk of trauma-related hospitalization. Findings could be used by providers during brief alcohol-related interventions with patients with alcohol misuse.

Falls: Why They Matter and What You Can Do

Falls are a leading cause of serious injuries in older adults. According to the Centers for Disease Control and Prevention, 1 in 3 adults aged 65 years and older falls each year. Approximately half of all people residing in nursing homes fall each year. Falls are the leading cause of injury death and also the most common cause of nonfatal injuries and hospital admissions for trauma for this population. In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments, and more than 581,000 of these individuals were hospitalized. Twenty to 30% suffer moderate to severe injuries, such as hip fractures or head traumas, which affect their ability to live independently and increase their risk of early death. The death rates from falls among older adults have risen sharply over the past decade. Many older adults who fall, even if they are not injured, develop a fear of falling that may cause them to limit their activities. A reduction in physical activity can lead to reduced mobility and loss of physical function that in turn increase the risk of falling. Reducing fall risk in older adults is an important public health concern. According to the American Geriatrics Society, most falls are caused by problems with walking, coordination, and balance. Falls among older adults are rarely due to a single cause and are often a result of multiple factors. The risk of falling increases as the number of risk factors increases. There are numerous risk factors for falls in older adults including: