The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2014
Are all deaths recorded equally? The impact of hospice care on risk-adjusted mortality.
Hospice care provides dignity and comfort at the end of life. While patients transferred to hospice die, they are often not recorded as in-hospital deaths in trauma registries or in some administrative discharge data. Mortality rates for the purpose of database research, performance improvement, or public reporting may therefore be artificially low. The current study sought to determine the impact of discharges to hospice on risk-adjusted mortality for trauma deaths reported to the Trauma Quality Improvement Program. ⋯ Given the large variation in the proportion of deaths recorded as discharged to a hospice rather than as in-hospital deaths, there is the potential for significant distortion of actual performance. Failure to consider this potential may misguide efforts directing performance improvement, research, and national reporting. Discharges to a hospice should be included with in-hospital deaths when reporting risk-adjusted mortality.
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J Trauma Acute Care Surg · Mar 2014
A concluding after-action report of the Senior Visiting Surgeon program with the United States Military at Landstuhl Regional Medical Center, Germany.
The Senior Visiting Surgeon (SVS) program at Landstuhl Regional Medical Center (LRMC), Germany, was developed during the wars in Afghanistan and Iraq as a measure to build military-civilian interaction in trauma care and research. The objective of this study was to provide a summary of the program including workload and experiences. An additional objective was to identify factors needed for sustainment of this program during an interwar period. ⋯ This study is the first to quantify the SVS program during the wars in Afghanistan and Iraq. Visiting surgeons provided more than 2 years of combat casualty care during these, the longest wars in US history. Continuation of this program will require expanded military-civilian interaction in trauma care, training, and research during any interwar period.
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J Trauma Acute Care Surg · Mar 2014
Multicenter StudyFrom 9-1-1 call to death: evaluating traumatic deaths in seven regions for early recognition of high-risk patients.
This study aimed to characterize initial clinical presentations of patients served by emergency medical services (EMS) who die following injury, with particular attention to patients with occult ("talk-and-die") presentations. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Mar 2014
How are you really feeling? A prospective evaluation of cognitive function following trauma.
Mild traumatic brain injury is associated with persistent cognitive difficulties. However, these symptoms may not be specific to the head injury itself. We sought to evaluate the prevalence of these symptoms in patients following trauma. ⋯ Prognostic/epidemiologic study, level II.
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J Trauma Acute Care Surg · Mar 2014
Blunt cerebrovascular injury screening guidelines: what are we willing to miss?
Blunt cerebrovascular injury (BCVI) is reported to occur in approximately 2% of blunt trauma patients, with a stroke rate of up to 20%. Guidelines for BCVI screening are based on clinical and radiographic findings. We hypothesized that liberal screening of the neck vasculature, as part of initial computed tomographic (CT) imaging in blunt trauma patients with significant mechanisms of injury, identifies BCVI that may go undetected. ⋯ Diagnostic study, level III.