1
|
Blackley SK, Lawrence J, Blevins A, Howell C, Butts CC, Polite NM, Capasso TJ, Bright AC, Hall KA, Haiflich AN, Williams AY, Kinnard CM, Mbaka MI, Audia JP, Simmons JD, Lee YL. A Single Hospital-Wide Antibiogram is Insufficient to Account for Differences in Antibiotic Resistance Patterns Across Multiple ICUs. Am Surg 2024:31348241241636. [PMID: 38597604 DOI: 10.1177/00031348241241636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Infection is a common cause of mortality within intensive care units (ICUs). Antibiotic resistance patterns and culture data are used to create antibiograms. Knowledge of antibiograms facilitates guiding empiric therapies and reduces mortality. Most major hospitals utilize data collection to create hospital-wide antibiograms. Previous studies have shown significant differences in susceptibility patterns between hospital wards and ICUs. We hypothesize that institutional or combined ICU antibiograms are inadequate to account for differences in susceptibility for patients in individual ICUs. METHODS Culture and susceptibility data were reviewed over a 1-year period for 13 bacteria in the following ICUs: Surgical/Trauma, Medical, Neuroscience, Burn, and Emergency department. Antibiotic management decisions are made by individual teams. RESULTS Nine species had sufficient data for inclusion into an All-ICU antibiogram. E coli and S aureus were the most common isolates. Seven species had significant differences in susceptibility patterns between ICUs. E cloacae showed higher rates of resistance to multiple antibiotics in the STICU than other ICUs. P aeruginosa susceptibility rates in the NSICU and BICU were 88% and 92%, respectively, compared to 60% and 55% in the STICU and MICU. Cephalosporins and Aztreonam had reduced efficacy against E coli in the NSICU, however remain effective in other ICUs. CONCLUSIONS The results of this study show that different ICUs do have variability in antibiotic susceptibility patterns within a single hospital. While this only represents a single institution, it shows that the use of hospital-wide antibiograms is inadequate for creating empiric antibiotic protocols within individual ICUs.
Collapse
Affiliation(s)
- Shem K Blackley
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jay Lawrence
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Addison Blevins
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Caroline Howell
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Thomas J Capasso
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Andrew C Bright
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Kayla A Hall
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | | | | | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jonathon P Audia
- Department of Microbiology and Immunology, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
- Department of Cellular & Molecular Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Yannleei L Lee
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
2
|
Jackson ML, Thomas SC, Joyner MR, Hu M, Larry Lee YL, Capasso T, Polite NM, Kinnard CM, Mbaka MI, Williams A, Simmons JD, Butts CC. Time to Mobility Is Associated With Pulmonary Complications in Patients With Spine Fractures. Am Surg 2024:31348241241702. [PMID: 38566605 DOI: 10.1177/00031348241241702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Treatment of spine fractures may require periods of prolonged immobilization which prevents effective pulmonary toileting. We hypothesized that patients with longer time to mobilization, as measured by time to first physical therapy (PT) session, would have higher pulmonary complications. METHODS We performed a retrospective review of all trauma patients with cervical and thoracolumbar spinal fractures admitted to a level 1 trauma center over a 12-month period. Demographic data collection included age, gender, BMI, pulmonary comorbidities, concomitant rib fractures, admission GCS, Injury Severity Score (ISS), GCS at 24 h, treatment with cervical or thoracolumbar immobilization, and time to first PT evaluation. The primary outcome was the presence of any one of the following complications: unplanned intubation, pneumonia, or mortality at 30 days. Multivariable logistic regression analysis was used to assess significant predictors of pulmonary complication. RESULTS In total, 491 patients were identified. In terms of overall pulmonary complications, 10% developed pneumonia, 13% had unplanned intubation, and 6% died within 30 days. In total, 19% developed one or more complication. Overall, 25% of patients were seen by PT <48 h, 33% between 48 and 96 h, 19% at 96 h to 1 week, and 7% > 1 week. Multivariable logistic regression analysis showed that time to PT session (OR 1.010, 95% CI 1.005-1.016) and ISS (OR 1.063, 95% CI 1.026-1.102) were independently associated with pulmonary complication. CONCLUSION Time to mobility is independently associated with pulmonary complications in patients with spine fractures.
Collapse
Affiliation(s)
- Michael L Jackson
- General Surgery Residency Program, University of South Alabama, Mobile, AL, USA
| | - Samuel C Thomas
- General Surgery Residency Program, Brookwood Baptist Health, Birmingham, AL, USA
| | - Matthew R Joyner
- General Surgery Residency Program, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Mengjie Hu
- Anesthesiology Residency Program, Wake Forest University, Winston-Salem, NC, USA
| | | | - Thomas Capasso
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
3
|
Michael JA, Roberts ME, Haiflich AN, Boyer E, Capasso TJ, Butts CC, Bright AC, Kinnard CM, Simmons JD, Williams AY, Lee YL, Polite NM, Mbaka MI. Effects of the COVID-19 Pandemic on the Trauma Population in a Level 1 Trauma Center. Am Surg 2023; 89:3962-3964. [PMID: 37144279 PMCID: PMC10160817 DOI: 10.1177/00031348231174005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In this study, we evaluated the effects of the pandemic on our trauma population. We performed a retrospective review of the trauma registry in the 2 years prior, and then 2 years during the pandemic. We evaluated age, race, gender, injury severity score (ISS), mechanism of trauma, rate of self-inflicted injury, rate of gunshot wounds (GSW), presence of EtOH, drug screen results, mortality, rate of burn traumas, and zip code of residence. Our query captured 5 054 patients before, and 5 731 during the pandemic. We found no statistical difference in age, gender, mechanism of trauma, rate of self-inflicted injuries, and mortality during the pandemic when compared to before. There were statistically significant differences in race, ISS, rate of GSWs, EtOH use, drug screen results, and burn traumas. Geospatial mapping found a rise in GSWs for zip code 36606. Gun violence and substance use rose in our trauma population during COVID-19.
Collapse
Affiliation(s)
- Javier A. Michael
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Morgan E. Roberts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew N. Haiflich
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Edwin Boyer
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Thomas J. Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Charles C. Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew C. Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Christopher M. Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jon D. Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Ashley Y. Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Yannlei L. Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Nathan M. Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Maryann I. Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| |
Collapse
|
4
|
Donnellan KA, Hinson CS, Blevins AC, Weaver KL, Lintner AC, Butts CC, Williams AY, Lee YLL, Simmons JD, Bright AC. Treatment of Chronic Hypertrophic Burn Scars With a Fractional CO 2 Laser Is Well Tolerated in an Outpatient Clinic Setting. Ann Plast Surg 2023; 90:444-446. [PMID: 36913562 DOI: 10.1097/sap.0000000000003526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The necessity of treating hypertrophic burn scars has expanded significantly with increased burn survivorship. Ablative lasers, such as carbon dioxide (CO 2 ) lasers, have been the most common nonoperative option for improving functional outcomes in severe recalcitrant hypertrophic burn scars. However, the overwhelming majority of ablative lasers used for this indication require a combination of systemic analgesia, sedation, and/or general anesthesia due to the painful nature of the procedure. More recently, the technology of ablative lasers has advanced and is more tolerable than their first-generation counterparts. Herein, we hypothesized that refractory hypertrophic burn scars can be treated by a CO 2 laser in an outpatient clinic. METHODS We enrolled 17 consecutive patients with chronic hypertrophic burn scars that were treated with a CO 2 laser. All patients were treated in the outpatient clinic with a combination of a topical solution (23% lidocaine and 7% tetracaine) applied to the scar 30 minutes before the procedure, Cryo 6 air chiller by Zimmer, and some patients received a mixture of N 2 O/O 2 . Laser treatments were repeated every 4 to 8 weeks until the patient's goals were met. Each patient completed a standardized questionnaire to assess tolerability and patient satisfaction of functional results. RESULTS All patients tolerated the laser well in the outpatient clinic setting, with 0% indicating "not tolerable," 70.6% "tolerable," and 29.4% "very tolerable." Each patient received more than 1 laser treatment for the following complaints: decreased range of motion (n = 16, 94.1%), pain (n = 11, 64.7%), or pruritis (n = 12, 70.6%). Patients were also satisfied with the results of the laser treatments ("no improvement or worsened" = 0%, "improved" = 47.1%, and "significant improvement" = 52.9%). The age of patient, type of burn, location of burn, presence of skin graft, or age of scar did not significantly affect the tolerability of treatment or satisfaction of outcome. CONCLUSIONS The treatment of chronic hypertrophic burn scars with a CO 2 laser is well tolerated in an outpatient clinic setting in select patients. Patients reported a high level of satisfaction with notable improvement in functional and cosmetic outcomes.
Collapse
Affiliation(s)
| | | | | | - Katrina L Weaver
- Division of Pediatric Surgery, Department of Surgery, University of South Alabama School of Medicine, Mobile, AL
| | | | | | | | | | | | | |
Collapse
|
5
|
Blackley SK, Smith WC, Lee YL, Kinnard C, Williams AY, Butts CC, Mbaka MI, Haiflich A, Bright A, Simmons JD, Polite NM. Identifying Radiographic and Clinical Indicators to Reduce the Occurrence of Nontherapeutic Laparotomy for Blunt Bowel and Mesenteric Injury. Am Surg 2023:31348231174009. [PMID: 37115715 DOI: 10.1177/00031348231174009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Roughly 5% of patients with blunt abdominal trauma (BAT) have a blunt bowel and/or mesenteric injury (BBMI). Determining the need for operative management in these patients can be challenging when hemodynamically stable. Single center studies have proposed scoring systems based on CT findings to guide management. Our study aimed to determine the predictability of abdominopelvic CT scan (CT A/P) findings in conjunction with clinical exam to determine the necessity of operative intervention for BBMI. METHODS Patients presenting from 2017 to 2022 to the University of South Alabama Level 1 Trauma Center after motor vehicle collision were retrospectively reviewed. Patients with CT findings suggestive of BBMI were further analyzed, noting CT findings, Glasgow coma scale (GCS), shock index, abdominal exam, operative or nonoperative management, and intraoperative intervention. RESULTS 1098 patients with BAT underwent CT A/P. 139 patients had ≥1 finding suggestive of BBMI. 38 patients underwent surgical exploration and 30 had surgically confirmed BBMI. 27 patients required intervention for BBMI. Univariate analysis indicated that pneumoperitoneum (p < 0.0001), active extravasation of contrast (p = 0.0001), hemoperitoneum without solid organ injury (SOI) (p < 0.0001), peritonitis (p < 0.0001), and mesenteric stranding(p < 0.05) were significantly associated with intervention. CONCLUSION In total, 30 patients had surgically confirmed BBMI. Active extravasation, pneumoperitoneum, hemoperitoneum without SOI, mesenteric stranding, and peritonitis were significant indicators of BBMI requiring intervention. CT and clinical findings cannot reliably predict the need for surgical intervention without ≥1 of these findings. Initial nonoperative management with serial clinical exams should be strongly considered to reduce incidence of nontherapeutic laparotomies.
Collapse
Affiliation(s)
- Shem K Blackley
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - William C Smith
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Yann-Leei Lee
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | | | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Andrew Haiflich
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
6
|
Cockrell BE, Haiflich AN, Lee YLL, Kinnard CM, Butts CC, Polite NM, Mbaka MI, Bright AC, Simmons JD, Williams AY. Social Determinants of Health Impact Physical Recovery After Blunt Injury. Am Surg 2023:31348231161672. [PMID: 36853832 DOI: 10.1177/00031348231161672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).
Collapse
Affiliation(s)
| | - Andrew N Haiflich
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Yann-Leei L Lee
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Maryann I Mbaka
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| |
Collapse
|
7
|
Dunbar EG, Massey AC, Lee YL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Simmons JD, Butts CC. Incidence and Severity of Medication Reconciliation Discrepancies in Trauma Patients. Am Surg 2023:31348231161686. [PMID: 36853593 DOI: 10.1177/00031348231161686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Trauma patients are especially vulnerable to inadvertent medication reconciliation discrepancies. We conducted a prospective study to evaluate the USA Health University Hospital's incidence and type of inadvertent medication reconciliation discrepancies among trauma patients. Patients were interviewed for accuracy of their admission medication reconciliation (AMR). Eighty-nine patients were included in this study. Twenty-six patients (29%) never received an AMR. There were 107 inadvertent medication reconciliation errors identified from 30 separate patients (48%), for a rate of 3.6 errors per patient with any error. There was a significant difference in the frequency of inadvertent medication reconciliation discrepancies for patients with >5 medication compared to those with fewer (P = .00029). In conclusion, trauma centers must be adequately staffed to provide timely, accurate, and available medication lists so that patients can be appropriately cared for.
Collapse
Affiliation(s)
- Elisabeth G Dunbar
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Ashley C Massey
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| |
Collapse
|
8
|
Massey AC, Dunbar EG, Lee YLL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Capasso TJ, Simmons JD, Butts CC. Incidence and Outcomes of Undiagnosed and Untreated Diabetes Mellitus in Trauma Patients. Am Surg 2023:31348231157888. [PMID: 36800323 DOI: 10.1177/00031348231157888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Diabetes is a major determinate for mortality in trauma patients. Many diabetics are undiagnosed or poorly controlled. Trauma patients disproportionately come from lower socioeconomic status, making missed diagnoses more likely. We aimed to quantify the incidence of undiagnosed or poorly controlled diabetics assessed at a Level 1 Trauma Center. We did a retrospective chart review of admitted trauma patients over a one-month period. Past Medical History, home medication lists, and Hemoglobin A1c on admission were recorded for each patient. We determined that 30 of 173 trauma patients qualifying for the study were diabetic. Furthermore, 30% of these diabetics were undiagnosed or had poorly controlled diabetes. Undiagnosed pre-diabetics made up 20% of the entire study group. Our data show that 26% of trauma patients would benefit from an intervention for improved glucose control. Trauma centers should consider creating routine clinical practice guidelines to identify at-risk patients and provide intervention for long-term management.
Collapse
Affiliation(s)
- Ashley C Massey
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Elizabeth G Dunbar
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Yann-Leei L Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Thomas J Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| |
Collapse
|
9
|
Farley P, Mullen PR, Taylor CN, Lee YL, Butts CC, Simmons JD, Brevard SB, Kinnard CM. The Treatment of Rib Fractures : A Single-Center Comparison. Am Surg 2020; 86:1144-1147. [PMID: 32845736 DOI: 10.1177/0003134820945219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rib fractures are a major problem characterized by pain, increased length of stay, and respiratory complications. Treatments include fixation, management with opiates, paraspinous local anesthetic pumps, and intercostal nerve blocks. The aim of this study was to evaluate the use of treatment options and compare clinically relevant outcomes. METHODS Patients admitted to a Level 1 trauma center with multiple rib fractures between 2015 and 2019 were screened. We included all participants treated with surgical fixation and/or intercostal nerve block or local anesthetic pump. Patients were case-matched 1:2 by Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) Chest and Head, age, and number of rib fractures. Outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, pneumonia, and tracheostomy rates. RESULTS We identified 25 patients who received rib fixation and intercostal analgesia. Of these, 14 cases were treated with liposomal bupivaicaine nerve block and 11 by paraspinous catheter block. Fifty control cases treated with opiates were identified. All patients survived to discharge. Cases and controls were approximately equivalent in age, ISS, number of fractured ribs, chest AIS, and head AIS. Rib-plated patients had a lower rate of pneumonia (OR 0.2029, 95% CI 0.0242, 0.09718), decreased average ICU LOS (10.62 vs 6.64, P = .018), and decreased average ventilator days (5.44 vs 1.68, P = .003). DISCUSSION Findings suggest more aggressive treatment of rib fractures may decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures. These findings are in line with current literature; however, more research is needed in this area.
Collapse
Affiliation(s)
- Paige Farley
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Parker R Mullen
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Catherine N Taylor
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Yannleei L Lee
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Sidney B Brevard
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA
| |
Collapse
|