- Email: [email protected]
Incidence and outcomes of thoracic aortic injuries with regionalized care in a mature trauma system
e142
Scientific Poster Presentations: 2015 Clinical Congress
INTRODUCTION: Within the United States, firearm-related injury accounts for a large portion of trauma center admissions and continues to be a major public health issue. Currently, little is known about indicators for firearm-related injury recidivism. We reviewed a Level I trauma center’s experience to characterize patterns in repeat firearm victims. METHODS: A retrospective review of a Level I trauma alert registry identified all patients who presented with a firearm-related injury from September 2003 to September 2013. All patients who presented more than once to the Trauma Center for a firearm-related injury were identified as recidivists. We evaluated patient demographics and outcomes. Parametric data was presented as meanstandard deviation and student t-test with a significance level of p<0.05. RESULTS: 5,112 patients were treated for firearm-related injuries over 10 years. 4,113 patients survived (80.5%). Of this, 113 patients were identified as firearm-related injury recidivists (2.75%). The recidivist cohort was entirely male, 87% Black, 8% Latin and 4% White. Average age of recidivists was 238.5 and an average age of 3015 in non-recidivists (p<.00001). All recidivists were intentional, interpersonal violence. Recidivists had average ISS of 1111 and non-recidivists with ISS 1415 (p¼0.0006). 18% of patients died after second firearm-related injury. Average time between injuries was 735641 days, with 13% of patients returned within one month. CONCLUSIONS: Firearm violence recidivism is a public health issue that disproportionally affects young black males. Further investigation is required to identify possible prevention strategies to reduce repeat victims. Incidence and outcomes of thoracic aortic injuries with regionalized care in a mature trauma system Donald G Harris, MD, Robert S Crawford, MD, FACS, Joseph Rabin, MD, Elena N Klyushnenkova, PhD, Hegang Chen, PhD, Thomas M Scalea, MD, FACS, Jose J Diaz, Jr, MD, FACS University of Maryland, Baltimore, Baltimore, MD INTRODUCTION: Thoracic aortic injury (TAI) is a leading cause of death after blunt trauma, but the effect of trauma system organization on outcomes is undefined. This was a statewide analysis of TAI in Maryland, with the hypothesis that regionalized TAI care is associated improved outcomes. METHODS: This was a retrospective study of TAI in Maryland between 2009 e 2013 using a statewide inpatient admission database. Presence of TAI and open or endovascular aortic interventions were identified by ICD-9 codes. Patients were compared by admitting hospital status, categorized as Level I or non-Level I trauma centers. Outcomes were overall inpatient mortality and death after aortic repair. RESULTS: Of 660,505 injured patients, 149 (0.02%) had TAI. Most (125, 85%) were admitted to Level I trauma centers, while
J Am Coll Surg
the remainder were seen at Level II, III, or non-designated hospitals. Demographics and injury patterns were similar between hospital groups. 41 patients (28%) underwent aortic intervention, primarily at Level I centers (38, 93%), which appeared to have lower overall mortality (22% vs 33%) and death after aortic repair (5% vs 33%), but these differences did not reach statistical significance. CONCLUSIONS: This novel population analysis indicates care of patients with TAI in Maryland is highly concentrated at Level I trauma centers, which was associated with mortality below previously reported national rates. Although limited by the small size of the non-Level I group, these findings suggest a benefit to regionalized care for patients with TAI, and support transfer to high-volume facilities for definitive management. Injury profile caused by anti-personnel improvised explosive devices Vivian C McAlister, MBBCh, FACS, Melissa Devine, Joseph Taddeo, MD, FACS University of Western Ontario, London, ON; Canadian Armed Forces Health Services, Ottawa, ON; Maine Veterans’ Affairs Medical Center, Augusta, ME INTRODUCTION: The profile of injury caused by antipersonnel landmines (AP-LM) is known. The antipersonnel improvised explosive device (AP-IED) has replaced AP-LM in recent conflicts. The target is injured more severely than bystanders. We wished to describe the injury pattern of the target of AP-IED, whom we defined as the dismounted victim of an IED with a traumatic amputation. METHODS: Information was collected regarding 100 consecutive dismounted AP-IED targeted patients with amputations treated in a NATO Role 3 medical facility. RESULTS: Of the patients, age 25 (18e44), 82% survived. Cervical collars and pelvic binders were rarely in place. Head, neck, tympanic membrane, chest and abdominal injuries were relatively rare (< 5%) with the exception of eye injuries (11%). Multiple limb amputations predominated (single 43; double 41; triple 13; quadruple 3). A mangled upper limb with loss of elbow joint but not the forearm and hand was a unique injury seen. Severe soft tissue injury with injection of contaminated soil along tissue planes well above entry sites was universal. Severe injury of the genitalia and perineum was common (34%) with disruption of the pelvic ring occurring in 11%. CONCLUSIONS: The injury profile is markedly worse for AP-IED than AP-LM. Field application of pelvic binders may reduce blood loss. Severe soft tissue injury and contamination increases the level of amputation and delays definitive surgery. The complex elbow injury requires innovative reconstruction to preserve function. These data support extension of personal protective equipment to include the perineum.
Scientific Poster Presentations: 2015 Clinical Congress
INTRODUCTION: Within the United States, firearm-related injury accounts for a large portion of trauma center admissions and continues to be a major public health issue. Currently, little is known about indicators for firearm-related injury recidivism. We reviewed a Level I trauma center’s experience to characterize patterns in repeat firearm victims. METHODS: A retrospective review of a Level I trauma alert registry identified all patients who presented with a firearm-related injury from September 2003 to September 2013. All patients who presented more than once to the Trauma Center for a firearm-related injury were identified as recidivists. We evaluated patient demographics and outcomes. Parametric data was presented as meanstandard deviation and student t-test with a significance level of p<0.05. RESULTS: 5,112 patients were treated for firearm-related injuries over 10 years. 4,113 patients survived (80.5%). Of this, 113 patients were identified as firearm-related injury recidivists (2.75%). The recidivist cohort was entirely male, 87% Black, 8% Latin and 4% White. Average age of recidivists was 238.5 and an average age of 3015 in non-recidivists (p<.00001). All recidivists were intentional, interpersonal violence. Recidivists had average ISS of 1111 and non-recidivists with ISS 1415 (p¼0.0006). 18% of patients died after second firearm-related injury. Average time between injuries was 735641 days, with 13% of patients returned within one month. CONCLUSIONS: Firearm violence recidivism is a public health issue that disproportionally affects young black males. Further investigation is required to identify possible prevention strategies to reduce repeat victims. Incidence and outcomes of thoracic aortic injuries with regionalized care in a mature trauma system Donald G Harris, MD, Robert S Crawford, MD, FACS, Joseph Rabin, MD, Elena N Klyushnenkova, PhD, Hegang Chen, PhD, Thomas M Scalea, MD, FACS, Jose J Diaz, Jr, MD, FACS University of Maryland, Baltimore, Baltimore, MD INTRODUCTION: Thoracic aortic injury (TAI) is a leading cause of death after blunt trauma, but the effect of trauma system organization on outcomes is undefined. This was a statewide analysis of TAI in Maryland, with the hypothesis that regionalized TAI care is associated improved outcomes. METHODS: This was a retrospective study of TAI in Maryland between 2009 e 2013 using a statewide inpatient admission database. Presence of TAI and open or endovascular aortic interventions were identified by ICD-9 codes. Patients were compared by admitting hospital status, categorized as Level I or non-Level I trauma centers. Outcomes were overall inpatient mortality and death after aortic repair. RESULTS: Of 660,505 injured patients, 149 (0.02%) had TAI. Most (125, 85%) were admitted to Level I trauma centers, while
J Am Coll Surg
the remainder were seen at Level II, III, or non-designated hospitals. Demographics and injury patterns were similar between hospital groups. 41 patients (28%) underwent aortic intervention, primarily at Level I centers (38, 93%), which appeared to have lower overall mortality (22% vs 33%) and death after aortic repair (5% vs 33%), but these differences did not reach statistical significance. CONCLUSIONS: This novel population analysis indicates care of patients with TAI in Maryland is highly concentrated at Level I trauma centers, which was associated with mortality below previously reported national rates. Although limited by the small size of the non-Level I group, these findings suggest a benefit to regionalized care for patients with TAI, and support transfer to high-volume facilities for definitive management. Injury profile caused by anti-personnel improvised explosive devices Vivian C McAlister, MBBCh, FACS, Melissa Devine, Joseph Taddeo, MD, FACS University of Western Ontario, London, ON; Canadian Armed Forces Health Services, Ottawa, ON; Maine Veterans’ Affairs Medical Center, Augusta, ME INTRODUCTION: The profile of injury caused by antipersonnel landmines (AP-LM) is known. The antipersonnel improvised explosive device (AP-IED) has replaced AP-LM in recent conflicts. The target is injured more severely than bystanders. We wished to describe the injury pattern of the target of AP-IED, whom we defined as the dismounted victim of an IED with a traumatic amputation. METHODS: Information was collected regarding 100 consecutive dismounted AP-IED targeted patients with amputations treated in a NATO Role 3 medical facility. RESULTS: Of the patients, age 25 (18e44), 82% survived. Cervical collars and pelvic binders were rarely in place. Head, neck, tympanic membrane, chest and abdominal injuries were relatively rare (< 5%) with the exception of eye injuries (11%). Multiple limb amputations predominated (single 43; double 41; triple 13; quadruple 3). A mangled upper limb with loss of elbow joint but not the forearm and hand was a unique injury seen. Severe soft tissue injury with injection of contaminated soil along tissue planes well above entry sites was universal. Severe injury of the genitalia and perineum was common (34%) with disruption of the pelvic ring occurring in 11%. CONCLUSIONS: The injury profile is markedly worse for AP-IED than AP-LM. Field application of pelvic binders may reduce blood loss. Severe soft tissue injury and contamination increases the level of amputation and delays definitive surgery. The complex elbow injury requires innovative reconstruction to preserve function. These data support extension of personal protective equipment to include the perineum.