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Zhou M, Norton TW, Rupp K, Paxton RJ, Wang MS, Rehman NS, He J. Level One Trauma Center Proliferation May Worsen Patient Outcomes. Am Surg 2024:31348241244647. [PMID: 38581578 DOI: 10.1177/00031348241244647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND From 2013 to 2020, Arizona state trauma system expanded from seven to thirteen level 1 trauma centers (L1TCs). This study utilized the state trauma registry to analyze the effect of L1TC proliferation on patient outcomes. METHODS Adult patients age≥15 in the state trauma registry from 2007-2020 were queried for demographic, injury, and outcome variables. These variables were compared across the 2 time periods: 2007-2012 as pre-proliferation (PRE) and 2013-2020 as post-proliferation (POST). Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were done for Injury Severity Score (ISS)≥15, age≥65, and trauma mechanisms. RESULTS A total of 482,896 trauma patients were included in this study. 40% were female, 29% were geriatric patients, and 8.6% sustained penetrating trauma. The median ISS was 4. Inpatient mortality overall was 2.7%. POST consisted of more female, geriatric, and blunt trauma patients (P < .001). Both periods had similar median ISS. POST had more interfacility transfers (14.5% vs 10.3%, P < .001). Inpatient, unadjusted mortality decreased by .5% in POST (P < .001). After adjusting for age, gender, ISS, and trauma mechanism, being in POST was predictive of death (OR: 1.4, CI:1.3-1.5, P < .001). This was consistent across all subgroups except for geriatric subgroup, which there was no significant correlation. DISCUSSION Despite advances in trauma care and almost doubling of L1TCs, POST had minimal reduction of unadjusted mortality and was an independent predictor of death. Results suggest increasing number of L1TCs alone may not improve mortality. Alternative approaches should be sought with future regional trauma system design and implementation.
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Affiliation(s)
- Michael Zhou
- Department of Surgery, Resident, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Taylor W Norton
- Department of Surgery, Resident, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Kelsey Rupp
- Department of Surgery, Resident, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Rebecca J Paxton
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Michele S Wang
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Nisha S Rehman
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Jack He
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Acute Care Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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Trauma Data Quality Improvement: One Center's Experience With Telecommuting and Paperless Data Management. J Trauma Nurs 2021; 27:170-176. [PMID: 32371736 DOI: 10.1097/jtn.0000000000000507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The American College of Surgeons requires that trauma centers collect and enter data into the National Trauma Data Registry in compliance with the National Trauma Data Standard. ProMedica supports employment of 4 trauma data analysts who are responsible for entering information in a timely manner, validating the data, and analyzing data to evaluate established benchmarks and support the performance improvement and patient safety process. Historically, these analysts were located on-site at ProMedica Toledo Hospital. In 2017, a proposal was developed including modifications to data collection to streamline processes, move toward paperless documentation, and allow for the analysts to telecommute. To measure the effect of these changes, the timeliness of data entry, rate of data validation, productivity, and staff satisfaction were measured. After the transition to electronic data management and home-based workstations, registry data were being entered within 30 days and 100% of cases were being validated, without sacrificing effective and efficient communication between in-hospital and home-based staff. The institution also benefitted from reduced expense for physical space, employee turnover, and decreased employee absenteeism. The analysts appreciated benefits related to time, travel, environment, and job satisfaction.It is feasible to transition trauma data analysts to a work-from-home situation. An all-electronic system of data management and communication makes such an arrangement possible and sustainable. This quality improvement project solved a workspace issue and was beneficial to the trauma program overall, with the timeliness and validation of data entry vastly improved.
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Watson D, Benton B, Ablah E, Lightwine K, Lusk R, Okut H, Bui T, Haan JM. Demographics and Incident Location of Traumatic Injuries at a Single Level I Trauma Center. Kans J Med 2021; 14:5-11. [PMID: 33643521 PMCID: PMC7833984 DOI: 10.17161/kjm.vol1413771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Traumatic injuries are preventable and understanding determinants of injury, such as socio-economic and environmental factors, is vital. This study evaluated traumatic injuries and identified areas of high trauma incidence. Methods A retrospective review was conducted of all patients 14 years or older who were admitted with a traumatic injury to a Level I trauma center between 2016 and 2017. Descriptive analyses were presented and maps of high injury areas were generated. Results The most frequent mechanisms of injury were falls (58.3%), motor vehicle crashes (22.3%), and motorcycle crashes (5.7%). Fall patients were more likely to be female (59.6%) and were the oldest age group (72.1 ± 17.2) compared to motor vehicle and motorcycle crash patients. Severe head (22.1%, p = 0.007) and extremity (35.7%, p = 0.001) injuries were most frequent among fall patients, however, more motorcycle crash patients required mechanical ventilation (16.1%, p < 0.001) and experienced the longest intensive care unit length of stay (5.3 ± 6.8 days, p < 0.001) and mechanical ventilation days (6.6 ± 8.5, p < 0.036). Motorcycle crash patients also had the greatest number of deaths (7.5%, p < 0.001). The generated maps of all traumas suggested that most injuries occur near our hospital and are located in several of the most population-dense zip codes. Conclusion Patient demographics, injury severity, and hospital outcomes varied by mechanisms of injury. Traumatic injuries occurred near our hospital and were located in several of the most populationdense zip codes. Injury prevention efforts should target high incident areas.
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Affiliation(s)
- David Watson
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Blair Benton
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Kelly Lightwine
- Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
| | - Ronda Lusk
- Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Thuy Bui
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - James M Haan
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS.,Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
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Comparing geographic information system-based estimates with trauma center registry data to assess the effects of additional trauma centers on system access. J Trauma Acute Care Surg 2020; 89:1131-1135. [PMID: 33230047 DOI: 10.1097/ta.0000000000002943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Geographic information systems (GISs) are often used to analyze trauma systems. Geographic information system-based approaches can model access to a trauma center (TC), including estimates of transport time and population coverage, when accurate trauma registry and emergency medical systems (EMS) data are not available. We hypothesized that estimates of trauma system performance calculated using a standard GIS method with public data would be comparable with trauma registry data. METHODS A standardized GIS-based method was used to estimate metrics of TC access in a regional trauma system in which the number of TCs increased from one to three during a 3-year period. Registry data from the index TC in the system were evaluated for different periods during this evolution. The number of admissions to the TC in different periods was compared with changes predicted by the GIS-based model, and the distribution of observed ground-based transportation times was compared with the predicted distribution. RESULTS With the addition of two TCs to the system, the volume of patients transported by ground to the index TC decreased by 30%. However, the model predicted a 68% decrease in population having the shortest predicted transport time to the index TC. The model predicted the geographic trend seen in the registry data, but many patients were transported to the index TC even though it was not the closest center. Observed transport times were uniformly shorter than predicted times. CONCLUSION The GIS-based model qualitatively predicted changes in distribution of trauma patients, but registry data highlight that field triage decisions are more complex than model assumptions. Similarly, transport times were systematically overestimated. This suggests that model assumptions, such as vehicle speed, based on normal traffic may not fully reflect emergency medical systems (EMS) operations. There remains great need for metrics to guide policy based on widely available data. LEVEL OF EVIDENCE Epidemiological, level III.
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Paydar S, Akbarialiabad H. Utilizing Novel Assessment and Instructional Methodologies of Trauma for Residents; A Case of Blended Learning in Shiraz Medical School. Bull Emerg Trauma 2020; 8:1-3. [PMID: 32201695 PMCID: PMC7071931 DOI: 10.29252/beat-080101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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American Association for the Surgery of Trauma Prevention Committee topical update: Impact of community violence exposure, intimate partner violence, hospital-based violence intervention, building community coalitions and injury prevention program evaluation. J Trauma Acute Care Surg 2020; 87:456-462. [PMID: 31349352 DOI: 10.1097/ta.0000000000002313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An effective injury prevention program is an important component of a successful trauma system. Maintaining support for a hospital-based injury prevention program is challenging, given competing institutional and trauma program priorities and limited resources. In light of those pressures, the American College of Surgeons Committee on Trauma mandates that trauma centers demonstrate financial support for an injury prevention program as part of the verification process, recognizing that hospital administrators might see such support as discretionary and ripe as a target for expense reduction efforts. This Topical Update from the American Association for the Surgery of Trauma Injury Prevention Committee focuses on strategies to be more effective with the limited resources that are allocated to hospital-based injury prevention programs. First, this review tackles two of the many social determinates of violence, including activities aimed at mitigating the impact of both community violence exposure and intimate partner/domestic violence. Developing or participating in coalitions for injury prevention, both in general with any injury prevention initiative, and specifically while developing a hospital-based violence intervention program, efficiently extends the hospital's efforts by gaining access to expertise, resources, and influence over the target population that the hospital might otherwise have difficulty impacting. Finally, the importance of systematic program evaluation is explored. In an era of dwindling resources for injury prevention, both at the national level and the institutional level, it is important to measure the effectiveness of injury prevention efforts on the target population, and when necessary, make changes to programs to both improve their effectiveness and to assist organizations in making wise choices in the use of their limited resources.
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Mclaughlin C, Slifko M, Hamill ME, Lollar DI, Stephenson K, Collier BR, Love KM. Changing the Landscape of Injury Prevention: Unlocking Geospatial Variables through Analysis of Lawn Mower Trauma. Am Surg 2018. [DOI: 10.1177/000313481808400408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Matthew Slifko
- LISA Collaboration Department of Statistics Virginia Tech Blacksburg, Virginia
| | - Mark E. Hamill
- Virginia Tech Carilion School of Medicine Roanoke, Virginia and the Section of Trauma/Surgical Critical Care Department of General Surgery Carilion Clinic Roanoke, Virginia
| | - Daniel I. Lollar
- Virginia Tech Carilion School of Medicine Roanoke, Virginia and the Section of Trauma/Surgical Critical Care Department of General Surgery Carilion Clinic Roanoke, Virginia
| | - Keith Stephenson
- Virginia Tech Carilion School of Medicine Roanoke, Virginia and the Section of Trauma/Surgical Critical Care Department of General Surgery Carilion Clinic Roanoke, Virginia
| | - Bryan R. Collier
- Virginia Tech Carilion School of Medicine Roanoke, Virginia and the Section of Trauma/Surgical Critical Care Department of General Surgery Carilion Clinic Roanoke, Virginia
| | - Katie M. Love
- Virginia Tech Carilion School of Medicine Roanoke, Virginia and the Section of Trauma/Surgical Critical Care Department of General Surgery Carilion Clinic Roanoke, Virginia
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Khorgami Z, Fleischer WJ, Chen YJA, Mushtaq N, Charles MS, Howard CA. Ten-year trends in traumatic injury mechanisms and outcomes: A trauma registry analysis. Am J Surg 2018; 215:727-734. [DOI: 10.1016/j.amjsurg.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
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Development of a trauma system and optimal placement of trauma centers using geospatial mapping. J Trauma Acute Care Surg 2018; 84:441-448. [DOI: 10.1097/ta.0000000000001782] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu JY, Hu QL, Ko CY. Databases for surgical health services research: National Trauma Data Bank and Trauma Quality Improvement Program. Surgery 2018; 164:919-920. [PMID: 29429579 DOI: 10.1016/j.surg.2017.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Jessica Y Liu
- American College of Surgeons, Chicago, IL; Department of Surgery, Emory University, Atlanta, GA.
| | - Q Lina Hu
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, CA
| | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, CA
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Shaw JJ, Psoinos CM, Santry HP. It's All About Location, Location, Location: A New Perspective on Trauma Transport. Ann Surg 2016; 263:413-8. [PMID: 26079917 DOI: 10.1097/sla.0000000000001265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors. BACKGROUND The existing literature on the mortality benefit of aeromedical transport on trauma mortality is controversial. Studies examining patient and injury characteristics find higher mortality, whereas studies measuring injury severity find a protective effect. Previous studies have not adjusted for the time and distance that would have been traveled had a helicopter not been used. METHODS Retrospective analysis of an institutional trauma registry. We compared mortality among adult patients (≥15 years) transported from the scene of injury to our level I trauma center by air or ground (January 1, 2000-December 31, 2010) using univariate comparisons and multivariable logistic regression. Regression models were constructed to incrementally account for patient demographics and injury mechanism, followed by injury severity, and, finally, by network bands for drive time and roadway distance as predicted by geographic information systems. RESULTS Of 4522 eligible patients, 1583 (35%) were transported by air. Patients transported by air had higher unadjusted mortality (4.1% vs 1.9%, P < 0.05). In multivariable modeling, including patient demographics and type of injury, helicopter transport predicted higher mortality than ground transport (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-4.0). After adding validated injury severity measures to the model, helicopter transport predicted lower mortality (OR 0.7, 95% CI 0.3-0.9). Finally, including geographic covariates found that helicopter transport was not associated with mortality (OR 1.1, 95% CI 0.6-2.3). CONCLUSIONS Helicopter transport does not impart a survival benefit for trauma patients when geographic considerations are taken into account.
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Affiliation(s)
- Joshua J Shaw
- *Department of Surgery University of Massachusetts Medical School, Worcester, MA †Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Freeman J, Rakotonirainy A. Mistakes or deliberate violations? A study into the origins of rule breaking at pedestrian train crossings. ACCIDENT; ANALYSIS AND PREVENTION 2015; 77:45-50. [PMID: 25681804 DOI: 10.1016/j.aap.2015.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 06/04/2023]
Abstract
Train pedestrian collisions are the most likely to result in severe injuries and fatalities when compared to other types of rail crossing accidents. However, there is currently scant research that has examined the origins of pedestrians' rule breaking at level crossings. As a result, this study examined the origins of pedestrians' rule breaking behaviour at crossings, with particular emphasis directed towards examining the factors associated with making errors versus deliberation violations. A total of 636 individuals volunteered to participate in the study and completed either an online or paper version of the questionnaire. Quantitative analysis of the data revealed that knowledge regarding crossing rules was high, although up to 18% of level crossing users were either unsure or did not know (in some circumstances) when it was legal to cross at a level crossing. Furthermore, 156 participants (24.52%) reported having intentionally violated the rules at level crossings and 3.46% (n=22) of the sample had previously made a mistake at a crossing. In regards to rule violators, males (particularly minors) were more likely to report breaking rules, and the most frequent occurrence was after the train had passed rather than before it arrives. Regression analysis revealed that males who frequently use pedestrian crossings and report higher sensation seeking traits are most likely to break the rules. This research provides evidence that pedestrians are more likely to deliberately violate rules (rather than make errors) at crossings and it illuminates high risk groups. This paper will further outline the study findings in regards to the development of countermeasures as well as provide direction for future research efforts in this area.
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Affiliation(s)
- James Freeman
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Queensland University of Technology, Australia.
| | - Andry Rakotonirainy
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Queensland University of Technology, Australia
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Calidad y registros en trauma. Med Intensiva 2015; 39:114-23. [DOI: 10.1016/j.medin.2014.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/22/2014] [Accepted: 06/29/2014] [Indexed: 11/21/2022]
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Niafar M, Hai F, Porhomayon J, Nader ND. The role of metformin on vitamin B12 deficiency: a meta-analysis review. Intern Emerg Med 2015; 10:93-102. [PMID: 25502588 DOI: 10.1007/s11739-014-1157-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/12/2014] [Indexed: 12/11/2022]
Abstract
Metformin is the only biguanide oral hypoglycemic drug, that is used to treat patients with type-2 diabetes mellitus. There are some reports of metformin being associated with decreased serum levels of vitamin B12 (VB12). The objective of this study is to systematically analyze the impact of metformin on the frequency of VB12 deficiency and serum levels of VB12. A search of various databases provided 18 retrospective cohort studies and 11 randomized controlled trials. Pooled estimates of odds ratio with 95% confidence interval using random effect model were conducted. Studies were examined for heterogeneity, publication bias and sensitivity analysis. Separate analysis of randomized control trials (RCTs) including both low-risk and high-risk bias was also conducted. 29 studies were selected with a total of 8,089 patients. 19 studies were rated intermediate or high quality. Primary outcome suggested increased incidence of VB12 deficiency in metformin group (OR = 2.45, 95% CI 1.74-3.44, P < 0.0001.) Heterogeneity was relatively high (I(2) = 53%), with minor publication bias. Secondary outcome suggested lower serum VB12 concentrations in metformin group (Mean difference = -65.8, 95% CI -78.1 to -53.6 pmol/L, P < 0.00001) with high heterogeneity (I(2) = 98%,) and low publication bias. RCTs analysis of low-and high-risk group revealed similar trends. We conclude that metformin treatment is significantly associated with an increase in incidence of VB12 deficiency and reduced serum VB12 levels.
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Affiliation(s)
- Mitra Niafar
- Tabriz University of Medical Sciences, Bone Research Center, Tabriz, Iran
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Abd Elrazek AE, Shehab A, Elnour AA, Al Nuaimi SK, Baghdady S. Colon in the chest: an incidental dextrocardia: a case report study. Medicine (Baltimore) 2015; 94:e507. [PMID: 25674744 PMCID: PMC4602738 DOI: 10.1097/md.0000000000000507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diaphragmatic injury is an uncommon traumatic injury (<1%). Although most diaphragmatic injuries can be obvious (eg, herniation of abdominal contents on chest radiograph), some injuries may be subtle and imaging studies can be nondiagnostic in many situations. Patients with diaphragmatic hernia either traumatic or nontraumatic may initially have no symptoms or signs to suggest an injury to the diaphragm.Here, we report a case of a 75-year-old woman diagnosed with irritable bowel syndrome -associated dominant constipation, presented with shortness of breath, cough, expectoration, tachycardia, and chest pain. Dextrocardia was an incidental finding, diagnosed by electrocardiography, chest radiograph, and CT chest. Parts of the colon, small intestine, and stomach were within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. Acquired incidental dextrocardia was the main problem due to displacement of the heart to contralateral side by the GI (gastrointestinal) viscera (left diaphragmatic hernia).The patient was prepared for the laparoscopic surgical repair, using a polyethylene mesh 20 cm to close the defect, and the patient recovered with accepted general condition. However, 5 days postoperative, the patient passed away suddenly due to unexplained cardiac arrest.Intrathoracic herniation of abdominal viscera should be considered in patients presented with sudden chest pain concomitant with a history of increased intra-abdominal pressure.
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Affiliation(s)
- Abd Elrazek Abd Elrazek
- From the Division of Liver Transplantation and Liver Research, Gastroenterology and Hepatology Department (AEAE), Faculty of Medicine, Al-Azhar University, Egypt; Cardiovascular Medicine Department (AS); Pharmacology Department (AAE), Faculty of Medicine and Health Sciences; Department of internal medicine (SKAN), United Arab Emirates University, United Arab Emirates; and Chest and ICU Department (SB), Faculty of Medicine, Aswan University, Egypt
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Abstract
Collaborative quality improvement has demonstrated success in improving quality and reducing health care costs in several state-based examples. Professional societies and payers are keen on identifying the most effective strategies to improve the safety and efficiency of surgical care. This review highlights the development and features of collaborative quality improvement programs, their advantages and examples of successful collaborations for several surgical conditions, and their potential application for surgeons caring for patients with upper extremity trauma and disability.
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Affiliation(s)
- Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, University of Michigan Health System, 1500 East Medical Center Drive, 2131 Taubman Center, Ann Arbor, MI 48109, USA.
| | - Nancy J O Birkmeyer
- Michigan Bariatric Surgery Collaborative, Center for Healthcare Outcomes and Policy, North Campus Research Complex, 2800 Plymouth Road, B016, Ann Arbor, MI 48109, USA; Department of Surgery, University of Michigan Medical Center, 1500 East Medial Center Drive, Ann Arbor, MI 48109, USA
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