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Lee A, Kroeker J, Evans DC. Complication reporting in trauma: An environmental scan and comparison of nationwide trauma registry data. Am J Surg 2024; 231:11-15. [PMID: 38360500 DOI: 10.1016/j.amjsurg.2024.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/26/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND To explore variability in quality measurement, this study aimed to compare abstraction and definitions of complications reported across trauma registries in Canada. METHODS A literature search was performed to identify active trauma registries used in Canadian hospitals. Registry characteristics, data abstraction, and reported complications and definitions based on registry data dictionaries were compared. RESULTS Nine registries were included, most of which were provincial-level registries (67 %). A total of 53 individual complications were identified. Twenty-one (40 %) were recorded by only one registry each whereas 5 (9 %) were collected by all. Of the 32 complications collected by > 1 registry, 18 (56 %) had different definitions. Of the 18 with different definitions, 12 (67 %), 5 (28 %), and 1 (6 %) had 2, 3, and 4 different definitions across registries, respectively. CONCLUSIONS Complications reported by trauma registries are variable. Reliable benchmarking is likely challenging, and efforts to standardize complication reporting may be a valuable undertaking.
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Affiliation(s)
- Alex Lee
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Jenna Kroeker
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - David C Evans
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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Sastry RA, Feler JR, Shao B, Ali R, McNicoll L, Telfeian AE, Oyelese AA, Weil RJ, Gokaslan ZL. Frailty independently predicts unfavorable discharge in non-operative traumatic brain injury: A retrospective single-institution cohort study. PLoS One 2022; 17:e0275677. [PMID: 36206233 PMCID: PMC9543962 DOI: 10.1371/journal.pone.0275677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Frailty is associated with adverse outcomes in traumatically injured geriatric patients but has not been well-studied in geriatric Traumatic Brain Injury (TBI). OBJECTIVE To assess relationships between frailty and outcomes after TBI. METHODS The records of all patients aged 70 or older admitted from home to the neurosurgical service of a single institution for non-operative TBI between January 2020 and July 2021 were retrospectively reviewed. The primary outcome was adverse discharge disposition (either in-hospital expiration or discharge to skilled nursing facility (SNF), hospice, or home with hospice). Secondary outcomes included major inpatient complication, 30-day readmission, and length of stay. RESULTS 100 patients were included, 90% of whom presented with Glasgow Coma Score (GCS) 14-15. The mean length of stay was 3.78 days. 7% had an in-hospital complication, and 44% had an unfavorable discharge destination. 49% of patients attended follow-up within 3 months. The rate of readmission within 30 days was 13%. Patients were characterized as low frailty (FRAIL score 0-1, n = 35, 35%) or high frailty (FRAIL score 2-5, n = 65, 65%). In multivariate analysis controlling for age and other factors, frailty category (aOR 2.63, 95CI [1.02, 7.14], p = 0.005) was significantly associated with unfavorable discharge. Frailty was not associated with increased readmission rate, LOS, or rate of complications on uncontrolled univariate analyses. CONCLUSION Frailty is associated with increased odds of unfavorable discharge disposition for geriatric patients admitted with TBI.
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Affiliation(s)
- Rahul A. Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
- * E-mail:
| | - Josh R. Feler
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Rohaid Ali
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Lynn McNicoll
- Division of Geriatrics, Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, United States of America
| | - Albert E. Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Robert J. Weil
- Department of Neurosurgery, Brain & Spine, Southcoast Health, Dartmouth, MA, United States of America
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, United States of America
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Ma LW, Kaufman EJ, Hatchimonji JS, Xiong R, Scantling DR, Stoecker JB, Holena DN. The Impact of Socially Stigmatized Preexisting Conditions on Outcomes After Injury. J Surg Res 2020; 257:511-518. [PMID: 32916504 DOI: 10.1016/j.jss.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/16/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Socially stigmatized preexisting conditions (SSPECs), including alcohol use disorder (AUD), drug use disorder (DUD), and major psychiatric illness, may lead to provider minimization of patient symptoms and have been associated with negative outcomes. However, the impact of SSPECs on failure to rescue (FTR) has not been evaluated. We hypothesized that SSPEC patients would have increased probability of complications, mortality, and FTR. MATERIALS AND METHODS We performed a retrospective analysis of the 2015 National Trauma Data Bank, including patients aged ≥18 y and excluding burn victims, patients with Injury Severity Score <9, and non-SSPEC patients with drug or alcohol withdrawal. We defined SSPECs using the National Trauma Data Bank's comorbidity recording codes for AUD, DUD, and major psychiatric illnesses. We built multivariable logistic regression models to determine the relationships between SSPECs and complications, mortality, and FTR. RESULTS We included 365,801 patients (62% male, 76% White, median age 56 y [interquartile range 35-74], median Injury Severity Score 10 [interquartile range 9-17]). After adjusting for patient and injury characteristics, SSPEC patients were more likely to have complications (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.70-1.79), less likely to die (OR 0.43, CI 0.38-0.48), and less likely to have FTR (OR 0.34, CI 0.26-0.43). SSPEC patients had a significantly higher complication rate (12.4% versus 7.2%; P < 0.001). After excluding drug or alcohol withdrawal, the complication rate remained significantly higher for SSPEC patients (9.3% versus 7.2%; P < 0.001). CONCLUSIONS Although SSPEC patients have lower odds of mortality and FTR, they are at higher probability of complications after injury. Further investigation into the causality behind the higher complications despite lower mortality and FTR is warranted.
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Affiliation(s)
- Lucy W Ma
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Elinore J Kaufman
- The Penn Injury Science Center at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin S Hatchimonji
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruiying Xiong
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dane R Scantling
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan B Stoecker
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- The Penn Injury Science Center at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Cunningham AJ, Dewey E, Hamilton NA, Schreiber MA, Krishnaswami S, Jafri MA. Validation of a venous thromboembolism prediction algorithm for pediatric trauma: A national trauma data bank (NTDB) analysis. J Pediatr Surg 2020; 55:1127-1133. [PMID: 32247600 DOI: 10.1016/j.jpedsurg.2020.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/20/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE We sought to validate a risk model to predict venous thromboembolism (VTE) in pediatric trauma through an analysis of a contemporary cohort in the National Trauma Data Bank (NTDB). STUDY DESIGN Prospective internal validation was performed in 10 randomly stratified samples of children (age 0-17 years) from the NTDB 2013-2016. Model discrimination was determined by calculation of the c-statistic (AUC), and calibration was evaluated through analysis of observed to expected (O:E) ratio. Recalibration was performed with application of a mixed-effects logistic regression. Model parameters were reestimated based on recalibration. RESULTS Retrospective review identified 481,485 pediatric trauma patients with 729 (0.2%) episodes of VTE. Discriminatory ability of the model in all random cohorts was significant with AUC > 0.93 (p < 0.001). Inadequate calibration was noted in 4 of 10 cohorts and the entire dataset (p < 0.001) with an O:E ratio of 1.79. Model recalibration resulted in similar discrimination (AUC = 0.95) with improved calibration (O:E ratio = 1.33, p < 0.0001). CONCLUSION Pediatric trauma prediction models can provide useful data for VTE risk stratification in injured children, but these models must be validated and calibrated prior to use. Recalibration of the model in question resulted in improved accuracy in a contemporary NTDB dataset. These data provide an appropriately calibrated and validated model for clinical use. LEVEL OF EVIDENCE II - Prospective internal validation of a multivariable prediction model.
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Affiliation(s)
- Aaron J Cunningham
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
| | - Elizabeth Dewey
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Nicholas A Hamilton
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Martin A Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Mubeen A Jafri
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA; Division of Pediatric Surgery, Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA
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Cunningham AJ, Dewey E, Lin S, Haley KM, Burns EC, Connelly CR, Moss L, Downie K, Hamilton NA, Krishnaswami S, Schreiber MA, Jafri MA. Pediatric trauma venous thromboembolism prediction algorithm outperforms current anticoagulation prophylaxis guidelines: a pilot study. Pediatr Surg Int 2020; 36:373-381. [PMID: 31900592 PMCID: PMC7223182 DOI: 10.1007/s00383-019-04613-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Venous thromboembolism (VTE) in injured children is rare, but sequelae can be morbid and life-threatening. Recent trauma society guidelines suggesting that all children over 15 years old should receive thromboprophylaxis may result in overtreatment. We sought to evaluate the efficacy of a previously published VTE prediction algorithm and compare it to current recommendations. METHODS Two institutional trauma registries were queried for all pediatric (age < 18 years) patients admitted from 2007 to 2018. Clinical data were applied to the algorithm and the area under the receiver operating characteristic (AUROC) curve was calculated to test algorithm efficacy. RESULTS A retrospective review identified 8271 patients with 30 episodes of VTE (0.36%). The VTE prediction algorithm classified 51 (0.6%) as high risk (> 5% risk), 322 (3.9%) as moderate risk (1-5% risk) and 7898 (95.5%) as low risk (< 1% risk). AUROC was 0.93 (95% CI 0.89-0.97). In our population, prophylaxis of the 'moderate-' and 'high-risk' cohorts would outperform the sensitivity (60% vs. 53%) and specificity (96% vs. 77%) of current guidelines while anticoagulating substantially fewer patients (373 vs. 1935, p < 0.001). CONCLUSION A VTE prediction algorithm using clinical variables can identify injured children at risk for venous thromboembolic disease with more discrimination than current guidelines. Prospective studies are needed to investigate the validity of this model. LEVEL OF EVIDENCE III-Clinical decision rule evaluated in a single population.
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Affiliation(s)
- Aaron J. Cunningham
- Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., CDW7, Portland, OR 97239 USA
| | - Elizabeth Dewey
- Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., CDW7, Portland, OR 97239 USA
| | - Saunders Lin
- Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., CDW7, Portland, OR 97239 USA
| | - Kristina M. Haley
- Division of Hematology and Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Erin C. Burns
- Division of Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Christopher R. Connelly
- Section of Transplantation Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI USA
| | - Lori Moss
- Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR USA
| | - Katie Downie
- Randall Children’s Hospital at Legacy Emanuel, Portland, OR USA
| | - Nicholas A. Hamilton
- Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR USA
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR USA
| | - Martin A. Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR USA
| | - Mubeen A. Jafri
- Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR USA
- Division of Pediatric Surgery, Randall Children’s Hospital at Legacy Emanuel, Portland, OR USA
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