Predicting Unplanned ICU Admission in Trauma: Early Warning Signs on the Floor.

Recovery Services for Interpersonal Violence Victims on Healthcare Use at a Trauma Center

The aim of this study was to evaluate demographics, characteristics, and mechanisms of injuries caused by lawnmowers in children. Chart review from 1990 to 2010 at a level I pediatric trauma center identified patients younger than 18 years with lawnmower injuries. Demographics and characteristics of the injuries were analyzed by descriptive statistical analysis. The study identified 88 subjects, with 80% males and 42% of the subjects younger than 5 years. When the lawnmower type was specified, riding lawnmowers caused the majority of injuries (72%). The most common mechanism of injury was related to slipping under lawnmower/being run over (51%). The most common injuries were lacerations (36%), fractures (27%), and amputations (22%); lower extremities were injured more frequently than other body areas (62%). The majority of patients (76%) required hospitalization with a mean length of stay (LOS) of 9.7 days and a mean number of procedures of 4. Complications included 6 infections, 1 tissue necrosis, and 1 death from hemorrhagic shock. Riding-lawnmower injuries were associated with younger children (P < 0.0001). Riding lawnmowers and younger age were associated with longer hospital LOS (P = 0.01, 0.006) and increased number of procedures (P = 0.03, 0.003, respectively). Lawnmower injuries are still prevalent in children despite national safety recommendations. Injuries seen with riding lawnmowers were associated with younger age, higher number of procedures, longer LOS, and more severe injuries.

Outcome of Hematopoietic Stem Cell Recipients Who Were Mechanically Ventilated and Admitted to Intensive Care Units

This study aims to explore the association between inpatient gout flare-related variables and the length of stay (LOS) in hospitalized people with comorbid gout. Using data from the Aotearoa/New Zealand national data collections, this cohort study included adults with comorbid gout who were admitted to publicly funded hospitals during 2017 for reasons other than gout. The primary outcome was LOS. Association between 20 variables and the LOS was explored using two generalized linear models. Directed acyclic graph (DAG) was constructed to evaluate the causal relationship between pre-admission urate lowering therapy (ULT) and LOS. The cohort included 36 047 admissions. We identified five variables associated with shorter LOS (pre-admission regular urate-lowering therapy (ULT), serum urate testing, male gender, Māori ethnicity and low-dose aspirin) and seven variables associated with longer LOS (M3 multimorbidity index, acute admission, operation, loop diuretics, potassium-sparing diuretics, NSAIDs, and age). Regular ULT had the strongest impact on shorter LOS (10% shorter). The model estimated an additional four days of hospitalization if the patient had multiple variables associated with longer LOS. DAG suggested a causal relationship between regular ULT and LOS under the condition that all unobserved confounders affected only ULT use, with no impact on in-hospital gout flares and/or LOS except through its influence on ULT use or as mediator of confounders that were observed. We have identified a set of gout flare-related variables found to be associated with LOS in hospitalized people with comorbid gout. Pre-admission ULT may help reduce the LOS in such patients.

Patients with Ruptured Abdominal Aortic Aneurysm Have Become Higher Risk

Influence of Sociodemographic and Psychosocial Factors on Length of Stay After Surgical Management of Traumatic Spine Fracture with Spinal Cord Injury

Analysis of Radiation Exposure in Trauma Patients at a Level I Trauma Center

The number of young women suffering acute myocardial infarction (AMI) is increasing. There are conflicting results on the prognostic impact of gender in young patients with AMI. The aim of the present study was to assess in-hospital and 5-year outcomes in men and women ≤50 years old admitted for AMI and participating in the FAST-MI programme. Methods FAST-MI consists in one-month nationwide French surveys of patients admitted for a recent AMI, repeated every 5 years since 2005. We used the 2005, 2010 and 2015 data with up to 5-year follow-up, to describe baseline characteristics and outcomes according to gender in young patients. Of 13,130 patients included, 1,912 were ≤50 years old (335 women, 17.5%). Results Men and women had a similar age (44±5 years), BMI, current smoking (72% vs 75%), diabetes, family history, prior history of CVD, GRACE score (104±22 vs 106±23), and LVEF (54±10%). LDL at admission was lower in women (127±46 vs 138±46 mg/dl). Women had a higher admission heart rate (81±19 vs 78±17 BPM) and lower systolic blood pressure (133±26 vs 136±25 mm Hg). Presenting AMI was STEMI in 63% in women vs 68% in men (P=0.08). All in-hospital complications except reinfarction (1.8 vs 0.6%, p&amp;lt;0.03) were similar in women and men; in-hospital death was 1.5% vs 0.8%, P=0.20. Coronary angiography was performed slightly less often (97.6% vs 99.0%, P=0.047) and more women had non-significant coronary artery disease (CAD) (13% vs 6%, P&amp;lt;0.001); PCI was less often used (74% vs 85.5%, P&amp;lt;0.001). At discharge, ESC guidelines-recommended medical treatment was less often prescribed in women (41% vs 53%, P&amp;lt;0.001), even in patients with significant CAD (46% vs 55%, P=0.004). Kaplan-Meier 5-year survival did not differ in women (94.7%) and men (95.2%), P=0.56 (Figure). The respective figures for hospital survivors were 96.1% and 96.0% (HR 1.00, 95% CI 0.52–1.91; HR adjusted on age, type of MI, previous history of CAD, presence of significant CAD, LVEF, Killip class and appropriate medications at discharge: 0.99, 95% CI 0.51–0.92). Similar results were found for the combined end-point of death, AMI or stroke. Conclusion There were more similarities than differences between women and men who sustained an AMI at age ≤50 years. Women had lower LDL-c, lower haemoglobin, higher heart rate and lower blood pressure on admission. Non-significant CAD was more frequently found in women, who were less often treated with PCI and recommended medications at discharge. Five-year outcomes, however, did not differ according to gender. Five-year mortality Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer, MSD, AstraZeneca

Disclosure: E. Burguera-Couce: None. G. Gopalakrishnan: None. V. Cheng: None. F. Monteiro: None. Objective: Our objective was to evaluate the impact of chronic kidney disease (CKD) stages on health outcomes in hospitalized individuals with Coronavirus disease 2019 (COVID-19) and type 1 diabetes (T1D) compared with type 2 diabetes (T2D). Methods: Data from 306 individuals with T1D admitted in Rhode Island with COVID-19 infection during the first-wave (March 1-June 30, 2020) and second-wave (July 1, 2020-February 28, 2021) were analyzed. Multivariate logistic regression was conducted to compare CKD stages for length of stay (LOS), ICU admission, mechanical ventilation (MV) and in-hospital mortality, and was adjusted for age, race/ethnicity, gender, insurance, and wave. Model investigating risk factors associated with poor outcomes (individuals admitted to ICU, being on MV or died in-hospital) was also adjusted in addition to BMI, hypertension (HTN), pulmonary disease, hyperglycemia, and LOS. The data was then compared to the results of our previously presented study with a cohort of 1122 individuals with type 2 diabetes (T2D), chronic kidney disease (CKD), and Coronavirus disease 2019 (COVID-19)1. Results: Average age 64.5 (±15.0) years; gender (54% male) and race/ethnicity (Caucasian 42%, Black 15% and Hispanic 29%) noted in T1DM cohort. CKD stages 1/2/3a, 3b/4, 5 represented 57.8%, 31.4% and 10.8%, respectively. Individuals with T1DM and CKD stages 4 &amp; 5 were more likely to have LOS ≥1-week (OR 3.1 [1.55-7.05] and 5.3 [1.95-14.14] respectively) and ICU admissions (13.4 [5.64-31.63] and 15.3 [6.03-39.01] respectively). CKD stages 3b, 4 &amp; 5 was associated with higher probability of MV (3.2 [1.18-8.67], 34.2 [10.77-108.52], 49.8 [14.37-172.73], respectively) and death (4.6 [1.9-19.15], 29.39 [7.90-109.34], 99.06 [20.90-469.54], respectively) in individuals with T1DM. These findings mirrored the trends found in individuals with DM21. However, the risk of poor outcomes was significantly higher in the T1DM cohort compared to T2DM for all CKD stages with mortality rates as high as 54.6% in individuals with DM1 and CKD Stage 5 compared to 28.6% in individuals with DM2 and CKD Stage 5. CKD stage-5 (17.4 [16.9-17.8]), CKD 3b/4 (4.9 [4.6-5.2]), hyperglycemia (7.5 [3.5-16.2]) and admission during the first-wave (2.7 [1.3-5.5]) were identified as risk factors for poor outcomes. Discussion/Conclusion: Our study showed that hospitalized individuals with T1D, CKD and COVID-19 experienced worse outcomes (i.e., MV, admission to the ICU, longer LOS and death) when compared to individuals with COVID-19, DM2 and CKD. Hyperglycemia was identified to be an independent risk factor for poor outcomes in this cohort. Reference: 1. Cheng V, Burguera-Couce E, Gopalakrishnan G, Monteiro F. “Poor Outcomes of Hospitalized COVID-19 Patients with Type 2 Diabetes and Chronic Kidney Disease.” Endocrine Practice, Volume 28, Issue 5, Supplement. https://doi.org/10.1016/j.eprac.2022.03.129. Presentation: Friday, June 16, 2023

BackgroundThe aim of this study was to elucidate associations between polypharmacy, types of medications, and geriatric comorbidities to identify predictive risk factors for poorer clinical outcomes following trauma-related falls in the geriatric population. Nearly 80% of trauma-related hospital admissions in the older adult population are secondary to falls, accounting for 3 million emergency department visits annually. Numerous studies have demonstrated associations between falls, polypharmacy, and other geriatric comorbidities, but studies outlining predictive risk factors for poor clinical outcomes are lacking.MethodsA retrospective cohort study of 1087 patients ≥ 65 years old who presented to Level 1 Trauma Center after a trauma-related fall. Comorbidities, current medication, demographic information, and clinical outcomes were identified to ascertain predictive risk factors for poorer clinical outcomes. Variables were assessed for statistical significance on unadjusted analysis. Variables found to be significant were entered into a multivariable logistic regression model to test for adjusted associations, with p < 0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals.ResultsPolypharmacy ≥ 4 medications (aOR 2.38 (1.10–5.15), p < .028) was an independent predictor of hospital readmission within 30 days. Chronic kidney disease, male gender, and Asian race had an increased association with ICU admission. History of malignancy (aOR 3.65 (1.62–8.19), p < .002) and chronic kidney disease (aOR 2.56 (1.11–5.96), p < .027) were independent predictors of 30-day mortality.ConclusionsPolypharmacy, chronic renal disease, malignancy history, male gender, and Asian race had an increased association of adverse clinical outcomes after falls in the geriatric population. Critical evaluation of patients with these risk factors may be needed to mitigate risk in this population.

Asthma as a comorbidity in COVID-19 pediatric ICU admissions in a large metropolitan children's hospital.

Background: Trauma injury scoring systems are essential for standardized assessment, treatment decisions, and outcome prediction in trauma patients. The mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure (MGAP) score offers a simplified approach that is particularly beneficial in resource-limited settings. This study aims to determine the association between the MGAP scoring system and mortality outcomes in trauma patients presenting to the trauma emergency unit (TEU) in a resource-limited setting. Objective: To determine the association between the MGAP scoring system and mortality outcomes in trauma patients presenting to the trauma emergency unit (TEU) in a resource-limited setting. Methods: A retrospective record review was conducted on priority 1 (P1) trauma patients aged 18 years or older who presented to the TEU of a hospital between 1 January 2022 and 31 December 2022. Data extracted from the TEU resuscitation register included age, sex, mechanism of injury, blood pressure (BP), and Glasgow Coma Scale (GCS). The primary outcome was survival versus death. MGAP scores were calculated, and statistical analyses were performed to assess the association between MGAP scores and mortality. Results: A total of 1220 patients were included in this study. The analysis revealed a statistically significant association between MGAP scores and mortality (p &lt; 0.0001). Lower MGAP scores were associated with higher mortality rates. Specifically, patients with MGAP scores ≤ 18 had a mortality rate of 48.1%, while those with scores between 19 and 22 had a mortality rate of 23.5%. The mortality rate was 2.2% for MGAP scores between 23 and 29, and 0% for scores ≥ 30. GCS score and systolic blood pressure were also significantly associated with mortality (p &lt; 0.0001 and p &lt; 0.05, respectively), while the mechanism of injury was not significantly associated with mortality. Conclusions: The MGAP score is a valuable tool for risk stratification in trauma patients in resource-constrained settings, demonstrating a strong inverse correlation with mortality outcomes. Its simplicity and reliance on readily available parameters make it particularly useful for rapid triage and resource allocation in LMICs. These findings support the implementation of the MGAP score in trauma triage protocols and highlight the need for further research to validate its performance in diverse LMIC settings and explore its potential for integration into national trauma care guidelines.

Objective. To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need. Methods. Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (ED) arrival. Included was any injured patient, regardless of injury severity. The interview collected patient physiologic condition, apparent anatomic injury, and mechanism of injury. Using the 1999 Scheme, patients who met the physiologic or anatomic steps were excluded. Patients were considered to need a trauma center if they had nonorthopedic surgery within 24 hours, had intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LRs) and 95% confidence intervals (CIs) for each mechanism-of-injury criterion. Results. A total of 11,892 provider interviews were conducted. Of those, one was excluded because outcome data were not available, and 2,408 were excluded because they met the other steps of the Field Triage Decision Scheme. Of the remaining 9,483 cases, 2,363 met one of the mechanism-of-injury criteria, 204 (9%) of whom needed the resources of a trauma center. Criteria with a +LR ≥5 were death of another occupant in the same vehicle (6.8; CI: 2.7–16.7), fall >20 feet (5.3; CI: 2.4–11.4), and motor vehicle crash (MVC) extrication time >20 minutes (5.1; CI: 3.2–8.1). Criteria with a +LR between >2 and <5 were intrusion >12 inches (4.2; CI: 2.9–5.9), ejection (3.2; CI: 1.3–8.2), and deformity >20 inches (2.5; CI: 1.9–3.2). The criteria with a +LR ≤2 were MVC speed >40 mph (2.0; CI: 1.7–2.4), pedestrian/bicyclist struck at a speed >5 mph (1.2; CI:1.1–1.4), bicyclist/pedestrian thrown or run over (1.2; CI: 0.9–1.6), motorcycle crash at a speed >20 mph (1.2; CI: 1.1–1.4), rider separated from motorcycle (1.0; CI: 0.9–1.2), and MVC rollover (1.0; CI: 0.7–1.5). Conclusion. Death of another occupant, fall distance, and extrication time were good predictors of trauma center need when a patient did not meet the anatomic or physiologic conditions. Intrusion, ejection, and vehicle deformity were moderate predictors.Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; predictors; mechanism of injury; trauma center

Loop diuretics are a cornerstone of heart failure (HF) treatment, but data regarding diuretic dose adjustments after a HF hospitalization and the association with subsequent outcomes are limited. This study was therefore conducted to determine these factors. We analysed data from 6119 patients enrolled in ASCEND-HF, examining the association between loop diuretic use at the time of discharge, compared with admission, and the composite outcome of 30-day HF re-hospitalization or all-cause mortality. The majority of patients, 3921 (64%), were taking a loop diuretic on admission. At discharge, 3411 (56%) patients were prescribed higher doses compared with admission, including 1867 (31%) initiating daily outpatient diuretics; 1912 (31%) had no dose change and 795 (13%) were prescribed lower doses compared with admission. Initiation of an oral loop diuretic at discharge was independently associated with better 30-day outcomes compared with no dose change [adjusted odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37-0.68]. However, for patients that were already established on a loop diuretic prior to admission, change in the dose at discharge was not associated with improved outcomes compared with no dose change (adjusted OR 0.92, 95% CI 0.79-1.07). In a large multinational clinical trial, 56% of patients hospitalized with HF were either initiated on a daily loop diuretic at discharge or discharged on higher doses compared with admission. In patients established on diuretics prior to hospitalization, we found no association between changes to chronic doses at discharge and improved outcomes, whereas initiation of loop diuretic therapy was associated with better outcomes compared with no dose change.

Epidemiological characteristics of injury in Georgia: A one-year retrospective study