- Email: [email protected]
328 A Prospective, Single-Center Study to Evaluate the Use of Skin Adhesive in the Closure of Scalp Wounds
Research Forum Abstracts ranged from 16% (length of stay ⬎ 2) to 35% (Injury Severity Score ⬎ 15); all specificities were above 97.5%. The improvement in outcome prediction and the increase in overtriage by including heart rate as a predictor are shown in the table. Nearly all patients with heart rate criterion and had the outcomes would have already been triaged to a trauma center due to the concurrent nature of physiologic criteria. The overtriage ratio, defined as the number of additional cases overtriaged by including heart rate divided by the number of additional outcomes predicted, range from 7.5 for admission to 20 for Injury Severity Score ⬎15. Conclusion: Overtriage ratios suggest that using heart rate as a predictor may result in many unnecessary patients being transported to trauma centers relative to the number of those who are appropriate transfers. However, the low incidence of patients with the heart rate criterion would not crowd trauma centers.
Table 1. Number of cases correctly triaged
Number of cases overtriaged
Outcome All PC All PC # added All PC All PC # added (# w/outcome) except HR plus HR by HR except HR plus HR by HR Admission (516) ICU (185) LOS ⬎ 2 (467) ISS ⬎ 15 (281) MOR-D (285)
328
89 60 76 97 77
99 65 84 101 83
10 5 8 4 6
338 367 351 350 370
413 447 428 431 449
75 80 77 81 79
A Prospective, Single-Center Study to Evaluate the Use of Skin Adhesive in the Closure of Scalp Wounds
Hendry PL, Kalynych CJ, Webb L, Westenbarger R, Lissoway J, Kumar V/University of Florida COM Jacksonville, Jacksonville, FL
Study Objectives: Dermal glues are commonly used for laceration repairs of the face but are rarely used in the US for scalp lacerations. Liquiband is a cyanoacrylate fast polymerizing wound glue used in the United Kingdom for scalp lacerations. To our knowledge, this is the first US study addressing dermal glue on scalp lacerations. The study purpose was to determine effectiveness of LiquiBand™ Flow Control skin adhesive for closure of scalp wounds. Emergency physicians measured ease of use, closure time, wound appearance, and complications. Patients assessed wound appearance post closure and pain level during application. Methods: This was an institutional review board approved prospective, follow-up pilot study of a convenience sample. Patients aged ⬎24 months seen in an emergency department (ED) with a scalp laceration were evaluated. Inclusion criteria were simple scalp lacerations ⬍ 5cm and ⬍ 6 hours old with easily approximated wound edges. Exclusions were multiple trauma, blood clotting disorders or blood thinning medications, animal or human bites, pregnancy, inadequate wound hemostasis or allergy to cyanoacrylate or formaldehyde. Consented patients had wounds cleaned and irrigated and a photo taken of the scalp wound prior to applying LiquiBand and post application. Data collected included: demographics, length of wound, anesthetic use, ease of application and satisfaction of closure. Patients rated wound closure pain on a Visual Analogue Scale. Patients were followed-up in ED 8-12 days post repair where physicians and patients rated satisfaction of closure. Physicians evaluated wounds for apposition, edema, inflammation, and infection and utilized a modified Hollander scale to further evaluate cosmesis. A follow-up photo was taken at the second visit. Four physician investigators were trained on LiquiBand use prior to the study and patients only recruited and seen for follow-up by study physicians. Results: Twenty-eight patients were screened for inclusion between January and April 2011. Eight were excluded due to prisoner status (4), wound too deep (3) or too small (1). At time of abstract, 15 patients met inclusion criteria and were consented with 14 completing follow-up. Thirteen were male, 53% White and 47% African American; age range 4-72 years. All scalp wounds achieved ⱖ 90% apposition (14), with 57% (n⫽8) achieving 100% apposition. There were no reports of dehiscence, infection, edema, or inflammation at follow-up and all patients (14) rated wound appearance as acceptable versus unacceptable. All but 1 reported their wound looked better (7) or much better (6) than expected. Additionally, all patients reported they would use LiquiBand again and reported very low pain scores during the procedure (M1.3; ⫹/-2.05). All physicians rated the wound as good or excellent with a mean Hollander score of 4.6; ⫹-.51. Mean application and closure time was 72 seconds (⫹/- 36.35). When asked to compare to other closure methods, physicians were highly satisfied (4.67; ⫹/-.62) on a scale of 1-5 and all would use LiquiBand again over staples or sutures.
S288 Annals of Emergency Medicine
Conclusion: This small pilot study demonstrates that Liquiband can be used safely for rapid closure of simple scalp lacerations with minimal pain and good to excellent cosmesis. There was a high level of physician and patient satisfaction. A larger prospective study is warranted. Skin adhesives should be considered for simple scalp laceration repair.
329
“Hey Doc, They Gonna Make It or Not?” and the 5020-10-2% Mortality Rule for Patients Up to Age 50
Babcock CI, Butcher P, Sizemore K/University of Michigan, Ann Arbor, MI; St. John Hospital and Medical Center, Detroit, MI
Introduction: Law enforcement agents frequently query clinicians for prognosis information of severely traumatized patients shortly after patient arrival and prior to complete delineation of all injuries. Hypotensive patients and those requiring intubation represent those with the highest mortality. A quick tool to stratify mortality based on need for intubation, age, and first systolic blood pressure is not currently available. Study Objective: To estimate mortality of blunt trauma patients with injuries severe enough to cause altered mental status requiring intubation (GCS8) using decade of age and first systolic blood pressure. Methods: Using the National Trauma Data Bank (6.2) the following variables were extracted: Age, Injury Type (⫽Blunt), Arrival Systolic Blood Pressure, Arrival GCS (8⫽ not intubated), ED Disposition, and Discharge status. Patients excluded if given sedatives or paralytics, if arrived DOA or if First Systolic Blood pressure⫽0. Blood pressure defined as hypotensive (0⬍SBP⬍89), normotensive (89⬍SBP139). Results: Of the 26446 patients needing intubation analyzed, 26% (6799) died. Hypotensive patients needing intubation had a mortality rate of approximately 50% up to age 50 (not significant gradual increase from 49% mortality age 0-10yrs to 54% for 61-70yrs, p⫽.35), and then sharply increased to 67% for patients ⬎80 yrs old (p⫽.03). Mortality rates for all normotensive age groups up to age 50yrs needing intubation was approximately 20% (16% mortality age 0-10yrs to 21% mortality age 41-50yrs), and increased starting at age ⬎50yrs (30% mortality 51-60yrs, 39% 6170yrs, 50% 71-80yrs, and 59% mortality if ⬎80yrs, p⬍.05). Of the 82856 patients with altered mental status not needing intubation (GCS 9-14), the mortality rate was approximately 10% if hypotensive and 2% of not hypotensive (1% age 0-10yrs to 3% age 41-50yrs, p⬍.05). Conclusion: Blunt trauma patients under age 50yrs arriving hypotensive needing intubation (GCS⬍9) have approximately a 50% mortality and if normotensive needing intubation have a mortality of approximately 20%. If patients have an altered mental status, but not severe enough to need intubation, the mortality rate is approximately 10% if hypotensive, and 2% if normotensive. As most blunt trauma patients are under age 50, this 50-20-10-2 % rule may be helpful for a quick mortality estimation based on need for intubation and hypotensive on arrival. Clinicians caring for these patients may find it helpful to provide these easy mortality estimations to families and law enforcement agents requesting immediate estimation of survival prior to complete evaluation of all injuries.
330
Measuring the Temporal Variation of Trauma-Related Visits to the Emergency Department: Is the Summer Weekend Trauma Surge a Reality?
Heavrin BS, Jenkins CA, Barrett TW/Vanderbilt University Medical Center, Nashville, TN
Study Objectives: It is widely acknowledged that patients with traumatic illness are more likely to present to the emergency department (ED) on weekends and in the summer. To our knowledge, the seasonal or weekend increase in ED patients with traumatic illness has not been quantified on a national level. Exploring the magnitude of this increase has important policy implications from an ED operational, staffing, and preparedness standpoint. Methods: We performed an ecological study examining United States ED visits in 2007 and 2008. We obtained data from the 2007 and 2008 Nationwide Emergency Department Sample (NEDS), the largest all-payer ED Database in the United States, managed by the Healthcare Utilization Project. Basic demographic and time series data were collected with appropriate weighting applied to the visits to make national-level estimates. We obtained counts of all ED visits in the NEDS database and then selected all visits linked to an ECode diagnosis, serving as a proxy for traumatic illness. We delineated the data by season (January-March; April-June; July-September; October-December) and by weekend (Saturday-Sunday) or weekday visit. We assumed that, if visits were random, 25% of ED visits would occur each
Volume , . : October
Table 1. Number of cases correctly triaged
Number of cases overtriaged
Outcome All PC All PC # added All PC All PC # added (# w/outcome) except HR plus HR by HR except HR plus HR by HR Admission (516) ICU (185) LOS ⬎ 2 (467) ISS ⬎ 15 (281) MOR-D (285)
328
89 60 76 97 77
99 65 84 101 83
10 5 8 4 6
338 367 351 350 370
413 447 428 431 449
75 80 77 81 79
A Prospective, Single-Center Study to Evaluate the Use of Skin Adhesive in the Closure of Scalp Wounds
Hendry PL, Kalynych CJ, Webb L, Westenbarger R, Lissoway J, Kumar V/University of Florida COM Jacksonville, Jacksonville, FL
Study Objectives: Dermal glues are commonly used for laceration repairs of the face but are rarely used in the US for scalp lacerations. Liquiband is a cyanoacrylate fast polymerizing wound glue used in the United Kingdom for scalp lacerations. To our knowledge, this is the first US study addressing dermal glue on scalp lacerations. The study purpose was to determine effectiveness of LiquiBand™ Flow Control skin adhesive for closure of scalp wounds. Emergency physicians measured ease of use, closure time, wound appearance, and complications. Patients assessed wound appearance post closure and pain level during application. Methods: This was an institutional review board approved prospective, follow-up pilot study of a convenience sample. Patients aged ⬎24 months seen in an emergency department (ED) with a scalp laceration were evaluated. Inclusion criteria were simple scalp lacerations ⬍ 5cm and ⬍ 6 hours old with easily approximated wound edges. Exclusions were multiple trauma, blood clotting disorders or blood thinning medications, animal or human bites, pregnancy, inadequate wound hemostasis or allergy to cyanoacrylate or formaldehyde. Consented patients had wounds cleaned and irrigated and a photo taken of the scalp wound prior to applying LiquiBand and post application. Data collected included: demographics, length of wound, anesthetic use, ease of application and satisfaction of closure. Patients rated wound closure pain on a Visual Analogue Scale. Patients were followed-up in ED 8-12 days post repair where physicians and patients rated satisfaction of closure. Physicians evaluated wounds for apposition, edema, inflammation, and infection and utilized a modified Hollander scale to further evaluate cosmesis. A follow-up photo was taken at the second visit. Four physician investigators were trained on LiquiBand use prior to the study and patients only recruited and seen for follow-up by study physicians. Results: Twenty-eight patients were screened for inclusion between January and April 2011. Eight were excluded due to prisoner status (4), wound too deep (3) or too small (1). At time of abstract, 15 patients met inclusion criteria and were consented with 14 completing follow-up. Thirteen were male, 53% White and 47% African American; age range 4-72 years. All scalp wounds achieved ⱖ 90% apposition (14), with 57% (n⫽8) achieving 100% apposition. There were no reports of dehiscence, infection, edema, or inflammation at follow-up and all patients (14) rated wound appearance as acceptable versus unacceptable. All but 1 reported their wound looked better (7) or much better (6) than expected. Additionally, all patients reported they would use LiquiBand again and reported very low pain scores during the procedure (M1.3; ⫹/-2.05). All physicians rated the wound as good or excellent with a mean Hollander score of 4.6; ⫹-.51. Mean application and closure time was 72 seconds (⫹/- 36.35). When asked to compare to other closure methods, physicians were highly satisfied (4.67; ⫹/-.62) on a scale of 1-5 and all would use LiquiBand again over staples or sutures.
S288 Annals of Emergency Medicine
Conclusion: This small pilot study demonstrates that Liquiband can be used safely for rapid closure of simple scalp lacerations with minimal pain and good to excellent cosmesis. There was a high level of physician and patient satisfaction. A larger prospective study is warranted. Skin adhesives should be considered for simple scalp laceration repair.
329
“Hey Doc, They Gonna Make It or Not?” and the 5020-10-2% Mortality Rule for Patients Up to Age 50
Babcock CI, Butcher P, Sizemore K/University of Michigan, Ann Arbor, MI; St. John Hospital and Medical Center, Detroit, MI
Introduction: Law enforcement agents frequently query clinicians for prognosis information of severely traumatized patients shortly after patient arrival and prior to complete delineation of all injuries. Hypotensive patients and those requiring intubation represent those with the highest mortality. A quick tool to stratify mortality based on need for intubation, age, and first systolic blood pressure is not currently available. Study Objective: To estimate mortality of blunt trauma patients with injuries severe enough to cause altered mental status requiring intubation (GCS8) using decade of age and first systolic blood pressure. Methods: Using the National Trauma Data Bank (6.2) the following variables were extracted: Age, Injury Type (⫽Blunt), Arrival Systolic Blood Pressure, Arrival GCS (8⫽ not intubated), ED Disposition, and Discharge status. Patients excluded if given sedatives or paralytics, if arrived DOA or if First Systolic Blood pressure⫽0. Blood pressure defined as hypotensive (0⬍SBP⬍89), normotensive (89⬍SBP139). Results: Of the 26446 patients needing intubation analyzed, 26% (6799) died. Hypotensive patients needing intubation had a mortality rate of approximately 50% up to age 50 (not significant gradual increase from 49% mortality age 0-10yrs to 54% for 61-70yrs, p⫽.35), and then sharply increased to 67% for patients ⬎80 yrs old (p⫽.03). Mortality rates for all normotensive age groups up to age 50yrs needing intubation was approximately 20% (16% mortality age 0-10yrs to 21% mortality age 41-50yrs), and increased starting at age ⬎50yrs (30% mortality 51-60yrs, 39% 6170yrs, 50% 71-80yrs, and 59% mortality if ⬎80yrs, p⬍.05). Of the 82856 patients with altered mental status not needing intubation (GCS 9-14), the mortality rate was approximately 10% if hypotensive and 2% of not hypotensive (1% age 0-10yrs to 3% age 41-50yrs, p⬍.05). Conclusion: Blunt trauma patients under age 50yrs arriving hypotensive needing intubation (GCS⬍9) have approximately a 50% mortality and if normotensive needing intubation have a mortality of approximately 20%. If patients have an altered mental status, but not severe enough to need intubation, the mortality rate is approximately 10% if hypotensive, and 2% if normotensive. As most blunt trauma patients are under age 50, this 50-20-10-2 % rule may be helpful for a quick mortality estimation based on need for intubation and hypotensive on arrival. Clinicians caring for these patients may find it helpful to provide these easy mortality estimations to families and law enforcement agents requesting immediate estimation of survival prior to complete evaluation of all injuries.
330
Measuring the Temporal Variation of Trauma-Related Visits to the Emergency Department: Is the Summer Weekend Trauma Surge a Reality?
Heavrin BS, Jenkins CA, Barrett TW/Vanderbilt University Medical Center, Nashville, TN
Study Objectives: It is widely acknowledged that patients with traumatic illness are more likely to present to the emergency department (ED) on weekends and in the summer. To our knowledge, the seasonal or weekend increase in ED patients with traumatic illness has not been quantified on a national level. Exploring the magnitude of this increase has important policy implications from an ED operational, staffing, and preparedness standpoint. Methods: We performed an ecological study examining United States ED visits in 2007 and 2008. We obtained data from the 2007 and 2008 Nationwide Emergency Department Sample (NEDS), the largest all-payer ED Database in the United States, managed by the Healthcare Utilization Project. Basic demographic and time series data were collected with appropriate weighting applied to the visits to make national-level estimates. We obtained counts of all ED visits in the NEDS database and then selected all visits linked to an ECode diagnosis, serving as a proxy for traumatic illness. We delineated the data by season (January-March; April-June; July-September; October-December) and by weekend (Saturday-Sunday) or weekday visit. We assumed that, if visits were random, 25% of ED visits would occur each
Volume , . : October