Articles: trauma.
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Observational Study
Accuracy of the Norwegian trauma protocol. An observational population study from South-Western Norway.
The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol. ⋯ Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.
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Americans experiencing homelessness are uniquely vulnerable to traumatic injuries and morbidity. Despite a high and increasing number of persons experiencing homelessness (PEH), American researchers have not comprehensively described the impact of this social problem on trauma patients in recent years. ⋯ This study describes differences in injury outcomes and clinical characteristics affecting homeless trauma patients compared to housed trauma patients since the COVID-19 pandemic, such as longer lengths of hospital stay, greater propensity to have violent injuries, and different discharge dispositions.
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Falls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions. ⋯ A significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.
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Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use. ⋯ In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.
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The majority of patients hospitalised for trauma survive their injuries, with the quality of the survival potentially influenced by early acute hospital rehabilitation. The aim of this study was to review the outcomes of patients managed under an intensive Allied Health Model of Care (AHMOC) compared to a baseline cohort. ⋯ This study shows an association between an AHMOC for trauma patients with a focus on early and intensive therapy and improved odds of discharge directly home, as well as improved 12 month return to work outcomes.