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Tilahun L, Zeleke M, Desu B, Dagnew K, Nega A, Birrie E, Estifanos N, Tegegne A, Feleke A. Time to recovery and its predictors following traumatic injuries among injured victims in Dessie Comprehensive Specialized Hospital, North East of Ethiopia, 2022: a retrospective follow-up study. BMC Emerg Med 2024; 24:44. [PMID: 38500020 PMCID: PMC10949805 DOI: 10.1186/s12873-024-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Injuries are an extremely important public health problem worldwide. Despite being largely preventable and despite government efforts, injuries continue to be a major public health issue. Thus, the study tends to evaluate the time to recovery and its predictors for traumatic injuries. METHODS A hospital-based retrospective follow-up study was used. A total of 329 medical charts were actually reviewed. Traumatic injury victims from January 1, 2018-December 31, 2022 were included, and a simple random sampling technique was utilized. The data was gathered by reviewing medical charts. Data was coded and entered into Epi-Data Manager version 4.6.0.4 statistical software and further analyzed using STATA version 17. Descriptive statistics were performed to see the frequency distribution of variables. A Kaplan-Meier survival estimate and log rank test were performed to plot the overall survival curve and compare the difference in recovery among predictor categories, respectively. A model fitness test was done by using the Cox-Snell residual test and Harrell's C concordance statistic. Finally, a Cox proportional hazard model was fitted to determine the effect of predictors on recovery time from traumatic injuries. RESULTS The median time to recovery of traumatic injuries was 5 days (IQR: 3-10 days), with an overall incidence density of 8.77 per 100 person-days of observation. In the multivariable cox proportional regression model, variables such as being male (AHR: 0.384, 95%CI: 0.190-0.776, P-value: 0.008), the Glasgow coma scale of 13-15 (AHR: 2.563, 95%CI: 1.070-6.139, P-value: 0.035), intentional injury (AHR: 1.934, 95%CI: 1.03-3.632, P-value: 0.040), mild traumatic brain injury (AHR: 2.708, 95%CI: 1.095-6.698, P-value: 0.031), and moderate traumatic brain injury (AHR: 2.253, 95%CI: (1.033-4.911, P-value: 0.041) were statistically significant variables. CONCLUSIONS The median recovery time for traumatically injured respondents was 5 days. Independent predictors such as the Glasgow coma scale, time taken for surgical management, intent of injury, and traumatic brain injury were statistically significant with time to recovery from trauma.
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Affiliation(s)
- Lehulu Tilahun
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia.
| | - Mulusew Zeleke
- College of Medicine and Health Sciences, Department of Adult Health Nursing, Wollo University, Dessie, Ethiopia
| | - Birhanu Desu
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Kirubel Dagnew
- College of Medicine and Health Sciences, Department of Comprehensive Nursing, Wollo University, Dessie, Ethiopia
| | - Aytenew Nega
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Endalk Birrie
- College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Wollo University, Dessie, Ethiopia
| | - Nathan Estifanos
- College of Medicine and Health Sciences, Department of Comprehensive Nursing, Wollo University, Dessie, Ethiopia
| | - Akele Tegegne
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Asresu Feleke
- College of Medicine and Health Sciences, Department of Emergency and Critical Care Nursing, Dilla University, Dilla, Ethiopia
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Francis AA, Wall JEM, Stone A, Dewane MP, Dyke A, Gregg SC. The Impact of Interdisciplinary Care on Cost Reduction in a Geriatric Trauma Population. J Emerg Trauma Shock 2020; 13:286-295. [PMID: 33897146 PMCID: PMC8047963 DOI: 10.4103/jets.jets_151_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/24/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022] Open
Abstract
The current growth of the geriatric population and increased burden on trauma services throughout the United States (US) has created a need for systems that can improve patient care and reduce hospital costs. We hypothesize that the multidisciplinary services provided through the Geriatric Injury Institute (GII) can reduce hospital costs, improve patient triage throughput, and decrease hospital length of stay (LOS).
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Affiliation(s)
- Andrew A Francis
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Joyce E M Wall
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Andrew Stone
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Michael P Dewane
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Ann Dyke
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Shea C Gregg
- Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
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Miller AN, Tilan J, Wellman A, Talton J, Usoro A, Sun K, Wuertzer S, Lenchik L, Stitzel J, Weaver A. Patient Age Is Inversely Associated with Injury Counts Caused by Motor Vehicle Crashes. J Surg Orthop Adv 2020; 29:36-38. [PMID: 32223864 PMCID: PMC7507971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Associations between age and fracture incidence, total number of fractures, and total number of injuries per occupant occurring in motor vehicle crashes were evaluated. An observational study of the Crash Injury Research and Engineering Network was conducted. Multivariable logistic regression and negative binomial models were used to relate age (2064, 65+ years) to fracture incidence, total number of fractures per occupant, and total number of injuries, adjusting for sex and change in vehicle velocity (deltav). Over 90% of occupants had at least one fracture for a total of 5,846 fracture injuries. The older age group experienced a 15% increase in the incidence of total injuries sustained compared to the younger group (Incident Rate Ratio = 1.15, 95% Confidence Interval = 1.081.23, p 0.0001). Older patients should be considered for polytrauma evaluation even with a lower energy motor vehicle crash. (Journal of Surgical Orthopaedic Advances 29(1):3639, 2020).
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Affiliation(s)
- Anna N Miller
- Washington University in St. Louis, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - Justin Tilan
- Washington University in St. Louis, Department of Orthopaedic Surgery, St. Louis, Missouri
| | | | - Jennifer Talton
- Wake Forest School of Medicine Department of Biomedical Engineering, WinstonSalem, North Carolina
| | - Andrew Usoro
- Wake Forest School of Medicine, WinstonSalem, North Carolina
| | - Katherine Sun
- Wake Forest School of Medicine Department of Radiology; WinstonSalem, North Carolina
| | - Scott Wuertzer
- Wake Forest School of Medicine Department of Radiology; WinstonSalem, North Carolina
| | - Leon Lenchik
- Wake Forest School of Medicine Department of Radiology; WinstonSalem, North Carolina
| | - Joel Stitzel
- Wake Forest School of Medicine Department of Biomedical Engineering, WinstonSalem, North Carolina
| | - Ashley Weaver
- Wake Forest School of Medicine Department of Biomedical Engineering, WinstonSalem, North Carolina
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Dodson BK, Braswell M, David AP, Young JS, Riccio LM, Kim Y, Calland JF. Adult and elderly population access to trauma centers: an ecological analysis evaluating the relationship between injury-related mortality and geographic proximity in the United States in 2010. J Public Health (Oxf) 2019; 40:848-857. [PMID: 29190373 PMCID: PMC6306086 DOI: 10.1093/pubmed/fdx156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background Ongoing development and expansion of trauma centers in the United States necessitates empirical analysis of the effect of investment in such resources on population-level health outcomes. Methods Multiple linear regressions were performed to predict state-level trauma-related mortality among adults and the elderly across 50 US states in 2010. The number of trauma centers per capita in each state and the percentage of each state’s population living within 45-min of a trauma center served as the key independent variables and injury-related mortality served as the dependent variable. All analyses were stratified by age (adult versus elderly; elderly ≥ 65 years old) and were performed in SPSS. Results The proportion of a population with geographic proximity to a trauma center demonstrates a consistent inverse linear relationship to injury-related mortality. The relationship reliably retains its significance in models including demographic covariates. Interestingly, access to Levels I and II trauma centers demonstrates a stronger correlation with mortality than was observed with Level III centers. Conclusion Trauma center access is associated with reduced trauma-related mortality among both adults and the elderly as measured by state reported mortality rates. Ongoing efforts to designate and verify new trauma centers, particularly in poorly-served ‘trauma deserts’, could lead to lower mortality for large populations.
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Affiliation(s)
- B K Dodson
- Eastern Virginia Medical School, School of Medicine, Norfolk, VA, USA
| | - M Braswell
- Institute for Advanced Studies in Culture, Charlottesville, VA, USA
| | - A P David
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J S Young
- School of Medicine, Department of Surgery- Division of Acute Care Surgery and Outcomes Research, University of Virginia, Charlottesville, VA, USA
| | - L M Riccio
- Winchester Medical Center, Acute Care Emergency Surgery Services, Winchester, VA, USA
| | - Y Kim
- School of Medicine, Department of Surgery- Division of Acute Care Surgery and Outcomes Research, University of Virginia, Charlottesville, VA, USA
| | - J F Calland
- School of Medicine, Department of Surgery- Division of Acute Care Surgery and Outcomes Research, University of Virginia, Charlottesville, VA, USA
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Abstract
Study design for a quality improvement project. Objective was to implement a geriatric trauma protocol (GTP) based on American College of Surgeons recommendations to improve patient outcomes. Geriatric trauma patients comprise a vulnerable and high-risk trauma population, and must be treated with specific protocols that take into account physiological, psychosocial, environmental, and pharmacological needs. A growing body of research and organizations such as the American College of Surgeons and the Eastern Association for the Surgery of Trauma recommend that a specific trauma protocol for geriatric adults must be utilized in hospitals and trauma centers. A retrospective chart review was conducted to assess geriatric patient outcomes prior to GTP implementation. Surgical residents then received training on the GTP, including performing additional diagnostics, referrals, and discussing goals of care early in treatment. The GTP was then implemented for 8 weeks and monitored to determine its effects on patient outcomes. The training for surgical residents in the GTP yielded a 9.2% increase in provider knowledge. The results of the GTP showed a reduced length of stay and increased geriatric consultations. More patients received a full evaluation by the trauma team, contributing the reduced length of stay. The use of a GTP shows promise in being able to improve patient outcomes, including morbidity and mortality. The principles of the GTP can be applied in all clinical settings, especially emergency rooms, which are on the frontlines of initial evaluations. In order to improve health care delivery to an aging population, organizations and clinicians should adopt a specialized GTP into their practices.
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Arya S, Long CA, Brahmbhatt R, Shafii S, Brewster LP, Veeraswamy R, Johnson TM, Johanning JM. Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. Ann Vasc Surg 2016; 35:19-29. [DOI: 10.1016/j.avsg.2016.01.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 01/18/2016] [Accepted: 01/22/2016] [Indexed: 12/21/2022]
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Strong BL, Torain JM, Greene CR, Smith GS. Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality. Am J Surg 2016; 212:638-644. [PMID: 27640909 DOI: 10.1016/j.amjsurg.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/16/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Racial disparities in trauma outcomes occur, but disparities in fall mortality are unknown. The objective of this study was to determine inhospital and 1-year fall mortality among patients discharged from an urban trauma center. METHODS We conducted a retrospective analysis of fall patients in our trauma registry (1997 to 2008) linked to the National Death Index to determine postdischarge mortality. Statistical analysis included chi-square tests, multivariable logistic regression, and Cox proportional hazards models. RESULTS There were 7,541 fall admissions. There was no clinically significant difference in inhospital mortality between blacks and whites with age stratification. One year after discharge, blacks younger than 65 years were more likely to die of disease (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.62). CONCLUSIONS Although rates of inhospital mortality are similar, blacks younger than 65 years have a higher risk of dying after discharge due to disease when stratified by age highlighting the need for continued medical follow-up and prevention efforts.
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Affiliation(s)
- Bethany L Strong
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA.
| | - Jamila M Torain
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA
| | - Christina R Greene
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA
| | - Gordon S Smith
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA
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Brook K, Camargo CA, Christopher KB, Quraishi SA. Admission vitamin D status is associated with discharge destination in critically ill surgical patients. Ann Intensive Care 2015; 5:23. [PMID: 26380991 PMCID: PMC4573737 DOI: 10.1186/s13613-015-0065-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/28/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Discharge destination after critical illness is increasingly recognized as a valuable patient-centered outcome. Recently, vitamin D status has been shown to be associated with important outcomes such as length of stay (LOS) and mortality in intensive care unit (ICU) patients. Our goal was to investigate whether vitamin D status on ICU admission is associated with discharge destination. METHODS We performed a retrospective analysis from an ongoing prospective cohort study of vitamin D status in critical illness. Patients were recruited from two surgical ICUs at a single teaching hospital in Boston, Massachusetts. All patients had 25-hydroxyvitamin D (25OHD) levels measured within 24 h of ICU admission. Discharge destination was dichotomized as non-home or home. Locally weighted scatterplot smoothing (LOWESS) was used to graph the relationship between 25OHD levels and discharge destination. To investigate the association between 25OHD level and discharge destination, we performed logistic regression analyses, controlling for age, sex, race, body mass index, socioeconomic status, acute physiology and chronic health evaluation II score, need for emergent vs. non-emergent surgery, vitamin D supplementation status, and hospital LOS. RESULTS 300 patients comprised the analytic cohort. Mean 25OHD level was 19 (standard deviation 8) ng/mL and 41 % of patients had a non-home discharge destination. LOWESS analysis demonstrated a near-inverse linear relationship between vitamin D status and non-home discharge destination to 25OHD levels around 10 ng/mL, with rapid flattening of the curve between levels of 10 and 20 ng/mL. Overall, 25OHD level at the outset of critical illness was inversely associated with non-home discharge destination (adjusted OR, 0.88; 95 % CI 0.82-0.95). When vitamin D status was dichotomized, patients with 25OHD levels <20 ng/mL had an almost 3-fold risk of a non-home discharge destination (adjusted OR, 2.74; 95 % CI 1.23-6.14) compared to patients with 25OHD levels ≥20 ng/mL. CONCLUSIONS Our results suggest that vitamin D status may be a modifiable risk factor for non-home discharge destination in surgical ICU patients. Future randomized, controlled trials are needed to determine whether vitamin D supplementation in surgical ICU patients can improve clinical outcomes such as the successful rate of discharge to home after critical illness.
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Affiliation(s)
- Karolina Brook
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 402, Boston, MA, 02114, USA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
| | - Kenneth B Christopher
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 402, Boston, MA, 02114, USA.
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
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DeLa'O CM, Kashuk J, Rodriguez A, Zipf J, Dumire RD. The Geriatric Trauma Institute: reducing the increasing burden of senior trauma care. Am J Surg 2014; 208:988-94; discussion 993-4. [DOI: 10.1016/j.amjsurg.2014.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/30/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
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