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Trauma Transfer

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1. Lead-Time Bias and Interhospital Transfer after Injury: Trauma Center Admission Vital Signs Underpredict Mortality in Transferred Trauma Patients. (PubMed)

Lead-Time Bias and Interhospital Transfer after Injury: Trauma Center Admission Vital Signs Underpredict Mortality in Transferred Trauma Patients. Admission physiology predicts mortality after injury, but may be improved by resuscitation before transfer. This phenomenon, which has been termed lead-time bias, may lead to underprediction of mortality in transferred patients and inaccurate benchmarking in centers receiving large numbers of transfer patients. We sought to determine the impact (...) of using vital signs on arrival at the referring center vs on arrival at the trauma center in mortality prediction models for transferred trauma patients.We performed a retrospective cohort study using a state-wide trauma registry including all patients age 16 years or older, with Abbreviated Injury Scale scores ≥ 3, admitted to level I and II trauma centers in Pennsylvania, from 2011 to 2014. The primary outcomes measure was the risk-adjusted association between mortality and interhospital transfer

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2016 Journal of the American College of Surgeons

2. Moving Along: Team Training for Emergency Room Trauma Transfers (T<sup>2</sup>ERT<sup>2</sup>). (PubMed)

Moving Along: Team Training for Emergency Room Trauma Transfers (T2ERT2). To determine whether high fidelity simulation-based training (SBT) of interprofessional teams involving trauma transfers has an immediate impact on participants' team-based attitudes and behaviors.A quasi-experimental, pre-/postintervention comparison design examined high fidelity SBT of inter-professional teams using a 2 scenario format with immediate after action structured debriefing. Pre (...) participants had matched RIPLS surveys. Statistically significant improvements in matched pre-/postscore differences occurred for all 15 IPT items. Observer TAS scores significantly improved on 2 of the 3 subscales comparing the second to the first scenario. Peer evaluations statistically improved comparing the second to the first scenario. Two of the 19 RIPLS items demonstrated statistically significant improvement.Interprofessional trauma team transfer training using SBT changes attitudes toward key team

2019 Journal of Surgical Education

3. Survival Benefit of Treatment at or Transfer to a Tertiary Trauma Center among Injured Older Adults. (PubMed)

Survival Benefit of Treatment at or Transfer to a Tertiary Trauma Center among Injured Older Adults. Objective: It is well established that seriously injured older adults are under-triaged to tertiary trauma centers. However, the survival benefit of tertiary trauma centers (TC) compared to a non-tertiary trauma centers (Non-TCs) remains unclear for this patient population. Using improved methodology and a larger sample, we hypothesized that there was a difference in hospital mortality between (...) injured older adults treated at TCs and those treated at Non-TCs. Methods: This was a retrospective cohort study of injured older adults (> =55 years) reported to the Oklahoma statewide trauma registry between 2005 and 2014. The outcome of interest was 30-day in-hospital mortality and the exposure variable of interest was level of definitive trauma care (TC vs Non-TC). Overall survival benefit of treatment at a TC as well as the survival benefit of transferring injured older adults to a TC were

2019 Prehospital emergency care

4. Outcomes after Motor Vehicle Trauma: Transfers to Level I Trauma Centers Compared with Direct Admissions. (PubMed)

Outcomes after Motor Vehicle Trauma: Transfers to Level I Trauma Centers Compared with Direct Admissions. The multilevel designation system given to U.S. trauma centers has proven useful in providing injury-level-appropriate care and guiding field triage. Despite the system, patients are often transferred to Level I trauma centers for higher-level care/specialized services.The objective of this study is to assess whether there is a difference in outcomes of patients transferred to Level I (...) centers, 5.7% (5691) of which were identified as trauma transfers. The lead admitting diagnosis for transfers was pelvic fracture (11.5%). Caucasians were 2.62 times as likely to be transferred as African-Americans (confidence interval 2.32-2.97), and 3.71 times as likely as Hispanics (confidence interval 3.25-4.23). Despite transfer patients having higher adjusted severity scores and higher adjusted risk of mortality, there were no differences in mortality (p = 0.95).Nationally, trauma transfers do

2017 Journal of Emergency Medicine

5. Transfer of Acutely Ill Pediatric Patients Transfer of Acutely Ill Pediatric Patients using Pediatric Transport Teams: Clinical Evidence and Guidelines

, critical care, infant, patient care management, patient care team, patient transfer, transportation of patients, critical illness, interfacility, interhospital, Acute care, Trauma, Severe, pediatric team Files Rapid Response Summary of Abstracts Published : January 26, 2018 Follow us: © 2019 Canadian Agency for Drugs and Technologies in Health Get our newsletter: (...) Transfer of Acutely Ill Pediatric Patients Transfer of Acutely Ill Pediatric Patients using Pediatric Transport Teams: Clinical Evidence and Guidelines Transfer of Acutely Ill Pediatric Patients using Pediatric Transport Teams: Clinical Evidence and Guidelines | CADTH.ca Find the information you need Transfer of Acutely Ill Pediatric Patients using Pediatric Transport Teams: Clinical Evidence and Guidelines Transfer of Acutely Ill Pediatric Patients using Pediatric Transport Teams: Clinical

2018 Canadian Agency for Drugs and Technologies in Health - Rapid Review

6. Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center (PubMed)

Impact of duplicate CT scan rate after implementation of transfer image repository system at a level 1 trauma center The regionalization of trauma in the USA results in frequent transfers of patients from a primary hospital ED to a higher level trauma facility. While many hospitals have a Picture Archive Communication System (PACS) which captures digital radiological images, these are often not available to the receiving institution resulting in duplicate imaging. The state of Arkansas (...) instituted a trauma image repository (TIR) in July 2013. We examined whether implementation of this repository would impact CT scan duplication in the trauma system.This was a retrospective analysis of trauma patients transferred from outlying hospitals in Arkansas and Missouri to a single level 1 trauma hospital in Missouri between July 2012 and June 2015. We compared the duplicate CT rate for patients transferred from Arkansas and Missouri hospitals before and after the repository was implemented

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2018 Emergency radiology

7. Transfer Time After Acceptance to a Level I Trauma Center (PubMed)

Transfer Time After Acceptance to a Level I Trauma Center Timely treatment of pediatric orthopaedic emergencies at level I trauma centers is frequently dependent on transfers from neighboring centers.Records were collected from our level I trauma center for patients with isolated orthopaedic issues accepted for transfer in 2015. Open fractures, compartment syndrome, septic arthritis, and supracondylar humerus fractures with ecchymosis or neurovascular compromise were emergent. The rush hour (...) was 6 am to 10 am and 3 pm to 7 pm.Ninety-six patients met the inclusion criteria; 19% (18/96) were orthopaedic emergencies and 37% (35/96) occurred during the rush hour. The average time from transfer acceptance to accepting hospital admission was 203 minutes (range, 68 to 584 minutes; SD, 85.8 minutes). The average time from transfer acceptance to departure from the transferring facility was 114 minutes (range, 7 to 391 minutes; SD, 71.9 minutes). There was no correlation between the transfer time

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2018 Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews

8. Insurance Status Biases Trauma-system Utilization and Appropriate Interfacility Transfer: National and Longitudinal Results of Adult, Pediatric, and Older Adult Patients. (PubMed)

Insurance Status Biases Trauma-system Utilization and Appropriate Interfacility Transfer: National and Longitudinal Results of Adult, Pediatric, and Older Adult Patients. To identify the association between insurance status and the probability of emergency department admission versus transfer for patients with major injuries (Injury Severity Score >15) and other complex trauma likely to require higher-level trauma center (TC) care across the spectrum of TC care.Trauma systems were developed (...) to facilitate direct transport and transfer of patients with major/complex traumatic injuries to designated TCs. Emerging literature suggests that uninsured patients are more likely to be transferred.Nationally weighted Nationwide Emergency Department Sample (2010-2014) and longitudinal California State Inpatient Databases/State Emergency Department Databases (2009-2011) data identified adult (18-64 yr), pediatric (≤17 yr), and older adult (≥65 yr) trauma patients. Risk-adjusted multilevel (mixed-effects

2018 Annals of Surgery

9. Evaluation of a Practice Improvement Protocol for Patient Transfer From the Emergency Department to the Surgical Intensive Care Unit After a Level I Trauma Activation. (PubMed)

Evaluation of a Practice Improvement Protocol for Patient Transfer From the Emergency Department to the Surgical Intensive Care Unit After a Level I Trauma Activation. ED boarding is a major issue in many hospitals. ED boarding occurs when there is insufficient hospital capacity to supply inpatient beds for admitted patients. ED boarding is not only a problem because of increased wait times for patients but also because it results in delays in administration of medication, higher rates (...) of complications, and increased mortality.In an attempt to improve patient flow and reduce time spent in the emergency department for patients requiring admission to the surgical intensive care unit (SICU), the emergency department, trauma service, and SICU collaborated on a guideline. The protocol developed focused on level I trauma-activated patients who were admitted directly from the emergency department to the SICU. We compared the transfer times before the protocol was initiated (January 1, 2016

2018 Journal of Emergency Nursing

10. Traumatic transfers: Calibration is adversely affected when prediction models are transferred between trauma care contexts in India and the US. (PubMed)

Traumatic transfers: Calibration is adversely affected when prediction models are transferred between trauma care contexts in India and the US. We evaluated the transferability of prediction models between trauma care contexts in India and the United States and explored updating methods to adjust such models for new contexts.Using a combination of prospective cohort and registry data from 3,728 patients of Towards Improved Trauma Care Outcomes in India (TITCO) and from 18,756 patients of the US (...) National Trauma Data Bank (NTDB), we derived models in one context and validated them in the other, assessing them for discrimination and calibration using systolic blood pressure, heart rate, and Glasgow coma scale as candidate predictors.Early mortality was 8% in the TITCO and 1-2% in the NTDB samples. Both models discriminated well, but the TITCO model overestimated the risk of mortality in NTDB patients, and the NTDB model underestimated the risk in TITCO patients.Transferability was good in terms

2016 Journal of Clinical Epidemiology

11. Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers. (PubMed)

Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers. Trauma patients sustaining blunt injuries are exposed to multiple radiologic studies. Evidence indicates that the risk of cancer from exposure to ionizing radiation rises in direct proportion to the cumulative effective dose (CED) received. The purpose of this study is to quantify the amount of ionizing radiation accumulated when (...) arriving directly from point of injury to San Antonio Military Medical Center (SAMMC), a level I trauma center, compared with those transferred from other facilities.A retrospective record review was conducted from 1st January 2010 through 31st December 2012. The SAMMC trauma registry, electronic medical records, and the digital radiology imaging system were searched for possible candidates. The medical records were then analyzed for sex, age, mechanism of injury, received directly from point of injury

2016 American Journal of Emergency Medicine

12. Impact of interhospital transfer on outcomes for trauma patients: a systematic review

Impact of interhospital transfer on outcomes for trauma patients: a systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.

2011 DARE.

13. Factors Associated With Nontransfer in Trauma Patients Meeting American College of Surgeons' Criteria for Transfer at Nontertiary Centers. (PubMed)

Factors Associated With Nontransfer in Trauma Patients Meeting American College of Surgeons' Criteria for Transfer at Nontertiary Centers. Secondary triage from nontertiary centers is vital to trauma system success. It remains unclear what factors are associated with nontransfer among patients who should be considered for transfer to facilities providing higher-level care.To identify factors associated with nontransfer among patients meeting American College of Surgeons (ACS) guideline criteria (...) for transfer from nontertiary centers.A retrospective cohort study was performed using multilevel logistic regression to ascertain factors associated with nontransfer from nontertiary centers, including demographics, injury characteristics, and center resources. With information obtained from the National Trauma Data Bank (January 1, 2007, to December 31, 2012), relative proportion of variance in outcome across centers was determined for patient-level and center-level attributes. In all, 96 528 patients

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2017 JAMA surgery

14. Patients Transferred for Upper Extremity Amputation: Participation of Regional Trauma Centers. (PubMed)

Patients Transferred for Upper Extremity Amputation: Participation of Regional Trauma Centers. Level-I trauma centers are required to provide hand and microsurgery capability at all times. We examined transfers to our center to better understand distant patient referrals and, indirectly, study referrals in our region.Records were reviewed from 2010 to 2015 to evaluate patients transferred to our level-I institution for upper extremity amputation. Patients were referred from 6 states to our (...) institution over this period. We measured the straight-line distance from each patient's transferring facility to our facility and compared this distance with the straight-line distances from the zip code of the transferring facility to the zip code of each level-I trauma center.We had data for 250 transferred patients (91% male, 9% female). For 110 patients (44%), our hospital was the nearest level-I trauma center; however, for the remaining 140 patients (56%), other level-I trauma facilities were

2017 Journal of Hand Surgery - American

15. Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study. (PubMed)

Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study. Traumatic injury is a leading cause of death in the United States, and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient-level factors associated (...) algorithm with the call records of the predominant telemedicine network in North Dakota. Multivariable generalized estimating equations were used to identify factors associated with telemedicine consultation and to measure the association between telemedicine consultation and interhospital transfer, adjusting for patient, injury, and hospital factors.Of the 9,281 North Dakota trauma patients seen in CAHs, 2,837 were treated in an ED with an active telemedicine subscription. Telemedicine was consulted

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2017 Academic Emergency Medicine

16. Opportunity to reduce transfer of patients with mild traumatic brain injury and intracranial hemorrhage to a Level 1 trauma center. (PubMed)

Opportunity to reduce transfer of patients with mild traumatic brain injury and intracranial hemorrhage to a Level 1 trauma center. Current guidelines do not address the disposition of patients with mild traumatic brain injury (TBI) and resultant intracranial hemorrhage (ICH). Emergency medicine clinicians working in hospitals without neurosurgery coverage typically transfer patients with both to a trauma center with neurosurgery capability. Evidence is accruing which demonstrates that the risk (...) of neurologic decompensation depends on the type of ICH and as a result, not every patient may need to be transferred. The purpose of this study was to identify risk factors for admission among patients with mild TBI and ICH who were transferred from a community hospital to the emergency department (ED) of a Level 1 trauma center.Study subjects were patients ≥18years of age who were transferred from a community hospital to the ED of an urban, academic Level 1 trauma center between April 1, 2015 and March 31

2017 American Journal of Emergency Medicine

17. Lymph node transfer for refractory infectious sites caused by trauma (PubMed)

Lymph node transfer for refractory infectious sites caused by trauma In this report, we placed focus on the immunological function of lymph nodes and performed lymph node transfer via a free flap to a site of refractory infection.Case 1 describes a 34-year-old male suffering from compound fractures with severe crush injuries and burns in the right ankle joint. A 20 × 15 cm skin defect was observed around the right malleolus medialis, along with denuded tendons with bacterial infection. After (...) conservative treatment, we transferred a lymph-node-containing free superficial circumflex iliac artery perforator flap to the region, with minimum debridement. No recurrence of wound infection appeared. Case 2 describes a 73-year-old male patient suffering from extensive contused wound in the right crus. Despite conservative treatment, the tibia gradually became denuded with computed tomography and magnetic resonance imaging revealing degeneration of the tibial cortex. We performed a free superficial

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2017 SAGE Open Medical Case Reports

18. Telemedicine Versus Emergency Transfer of Trauma Patients: A Systematic Review

Telemedicine Versus Emergency Transfer of Trauma Patients: A Systematic Review "Telemedicine Versus Emergency Transfer of Trauma Patients: A Systemati" by Jason Olson < > > > > > Title Author Date of Graduation Fall 8-9-2014 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies Rights . Abstract Background: There are disproportionally high rates of traumatic injuries in rural populations with high rates of mortality. Rural trauma patients are more likely (...) to be transferred to a Level 1 trauma center for definitive care than are trauma patients in urban settings. Telemedicine offers the ability to bring the trauma center to the rural patient allowing advanced assessment, resuscitation, and disposition at the local community hospital. Through the means of telemedicine, the number of trauma transfers can be reduced which will in turn reduce costs to the healthcare system while improving patient care. Methods: A comprehensive search was performed using multiple

2014 Pacific University EBM Capstone Project

19. A trauma network with centralized and local health care structures: Evaluating the effectiveness of the first certified Trauma Network of the German Society of Trauma Surgery. (PubMed)

A trauma network with centralized and local health care structures: Evaluating the effectiveness of the first certified Trauma Network of the German Society of Trauma Surgery. Trauma is a global burden of disease and one of the main causes of death worldwide. Therefore, many countries around the world have implemented a wide range of different initiatives to minimize mortality rates after trauma. One of these initiatives is the bundling of treatment expertise in trauma centers (...) and the establishment of trauma networks. Germany has a decentralized system of trauma care medical centers. Severely injured patients ought to receive adequate treatment in both level I and level II centers. This study investigated the effectiveness of a decentralized network and the question whether level I and level II centers have comparable patient outcome.In 2009, the first trauma network DGU® in Germany was certified in the rural area of Eastern Bavaria. All patients admitted to the 25 participating

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2018 PLoS ONE

20. Assessment of abdominal trauma

Assessment of abdominal trauma Assessment of abdominal trauma - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of abdominal trauma Last reviewed: February 2019 Last updated: August 2018 Summary Trauma is a physical injury caused by transfer of energy to and within the person involved. Abdominal trauma is best categorised by mechanism as blunt or penetrating abdominal injury. The mechanism of injury (...) dictates the diagnostic work-up. As there is a broad spectrum of abdominal injuries, abdominal trauma patients are often difficult to assess. Confounding factors, such as associated extra-abdominal injuries or altered mental status (either from a head injury or intoxication), further complicate the evaluation. Enderson BL, Reath DB, Meadors J, et al. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990 Jun;30(6):666-9. http://www.ncbi.nlm.nih.gov/pubmed/2352294?tool

2018 BMJ Best Practice

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