- Email: [email protected]
Patient Experiences of Trauma Resuscitation
S114
J Am Coll Surg
Scientific Forum Abstracts
volume centers (28.2% vs 24.3%, p<0.01). Adjusted pCR rates for luminal A tumors were significantly higher at all center types compared to community centers and at certain regions of the country compared to the Northeast region. However, pCR rates amongst TNBC and Her2 + tumors were the same across all center types and nearly all center locations. Centers with >¼10% NAC volume had significantly higher pCR rates then centers with <10% NAC volume across all tumor subtypes (Luminal A: OR1.15 (1.06-1.26),TNBC: OR1.11 (1.03-1.20), Her2 +: OR1.16 (1.08-1.24)).
Patterns of Use and Factors Associated with Early Discontinuation of Opiates after Major Trauma Muhammad Ali Chaudhary, MBBS, Rebecca Scully, MD, Ritam Chowdhury, MBBS, MPH, PhD, Meesha Sharma, MBBS, Juan P Herrera-Escobar, MD, Cheryl K Zogg, Elizabeth J Lilley, MD, MPH, Wei Jiang, Andrew Schoenfeld, MD, Adil H Haider, MD, MPH, FACS Brigham and Women’s Hospital, Boston, MA
CONCLUSIONS: NAC volume, center type, and location were associated with higher pCR rates for luminal A tumors but only volume of NAC was associated with higher pCR for TNBC and Her2 + subtypes.
INTRODUCTION: The inappropriate use of prescription opiates is a growing public-health issue in the United States. There is wellfounded concern that over-prescription may fuel abuse and dependency. We evaluated patterns of use and factors associated with discontinuation of opiates after major trauma.
Patient Experiences of Trauma Resuscitation Elinore J Kaufman, MD, Therese S Richmond, PhD, Douglas J Wiebe, PhD, Sara F Jacoby, PhD, CW Schwab, MD, Daniel N Holena, MD, FACS University of Pennsylvania, Philadelphia, PA, New YorkPresbyterian Weill Cornell, New York, NY
METHODS: The 2007e2010 military healthcare data from TRICARE database was queried for individuals 18 to 64 years of age, admitted after trauma with an Injury Severity Score (ISS) >9. Riskadjusted Cox Proportional-Hazard model was used to identify predictors of opiate-discontinuation post-discharge, with rank as a proxy for socioeconomic status (SES).
INTRODUCTION: Patient-centered care is an important aspect of quality, but is rarely assessed in an emergency context. In trauma resuscitation (TR), rapid assessment and treatment leaves little room to identify and address individual concerns. We conducted qualitative interviews and observations to assess how patients’ experiences of TR mesh with rapidly progressing clinical events.
RESULTS: Of the 7,302 individuals who met our inclusion criteria, 49% filled at least 1 opiate prescription post-discharge. 8.8% continued opiate use at 3 months, 3.8% at 6 months, and 0.9% at 1 year. In multivariate analysis, older age (45-64 years vs 18-24 years: HR¼0.84, p<0.01), being married (HR¼0.92, p¼0.01), enlisted status vs officer (Junior-Enlisted HR¼0.89, p¼0.02), and length of stay (LOS) (HR¼0.99, p<0.01) were associated with decreased likelihood of discontinuing opiate use while no differences were observed based on race, gender, ISS or diagnosis of depression or anxiety (Table).
METHODS: We conducted 30 semi-structured interviews with patients within 2 days of TR and 20 observations of video-recorded TRs at an urban, academic Level I trauma center. Data were analyzed for thematic content in NVIVO using modified grounded theory. The codebook was refined iteratively. Interrater reliability was calculated with Cohen’s kappa. RESULTS: Of interview participants, 83% were male, 70% were black, and 47% were injured in interpersonal violence. Median age was 44. Inter-rater reliability was excellent (k¼0.93). Participants’ emotional responses included fear, loss of control, and comfort. Sources of satisfaction included providers’ kindness, reassuring communication, and clinical expertise. The number and speed of providers were overwhelming, but reinforced participants’ confidence in the team’s expertise. Cutting clothing, perceptions of inexpert care, and limited or exclusionary communication contributed to dissatisfaction. Participants described altered awareness during TR, and omitted many clinical interactions and procedures seen in observations. Observations provided greater detail about providers’ communication, and of how providers used words, touch, and position to give comfort. CONCLUSIONS: Patient concerns were well aligned with clinical TR goals. However, participants’ emotions, non-clinical concerns, and dissatisfactions were rarely captured by our observations. Quality improvement in TR should address both observed and unobserved features of patient experience.
Table. Factors Associated with Discontinuation of Opiates Use up to 1 Year After Trauma Discharge Characteristic
Hazards ratio
95% CI
p Value
Age (45-64)* Race (black)** Married Rank+ Senior Enlisted Junior Enlisted Length of stay ISS (15-24)++ Anxiety Depression
0.84 1.07 0.92
0.76-0.93 0.99-1.28 0.87-0.97
<0.01 0.08 0.01
0.91 0.89 0.99 0.98 1.07 0.96
0.84-0.99 0.81-0.98 0.99-0.99 0.92-1.03 0.95-1.21 0.86-1.06
0.03 0.02 <0.01 0.43 0.24 0.44
Multivariable Cox Proportional Hazards Model adjusted for race, gender, injury severity score, diagnosis of depression and anxiety, co-morbidities, facility of care, and geographic region. a¼0.05. *Reference: 18-24, **Reference: White, +Reference: Officer, ++Reference: 9-14
CONCLUSIONS: At 3 months post-discharge, a majority of patients had discontinued opiate use. Sociodemographic factors such as advanced age, marital status and low SES were significantly associated with lower likelihood of opiate-discontinuation while
J Am Coll Surg
Scientific Forum Abstracts
volume centers (28.2% vs 24.3%, p<0.01). Adjusted pCR rates for luminal A tumors were significantly higher at all center types compared to community centers and at certain regions of the country compared to the Northeast region. However, pCR rates amongst TNBC and Her2 + tumors were the same across all center types and nearly all center locations. Centers with >¼10% NAC volume had significantly higher pCR rates then centers with <10% NAC volume across all tumor subtypes (Luminal A: OR1.15 (1.06-1.26),TNBC: OR1.11 (1.03-1.20), Her2 +: OR1.16 (1.08-1.24)).
Patterns of Use and Factors Associated with Early Discontinuation of Opiates after Major Trauma Muhammad Ali Chaudhary, MBBS, Rebecca Scully, MD, Ritam Chowdhury, MBBS, MPH, PhD, Meesha Sharma, MBBS, Juan P Herrera-Escobar, MD, Cheryl K Zogg, Elizabeth J Lilley, MD, MPH, Wei Jiang, Andrew Schoenfeld, MD, Adil H Haider, MD, MPH, FACS Brigham and Women’s Hospital, Boston, MA
CONCLUSIONS: NAC volume, center type, and location were associated with higher pCR rates for luminal A tumors but only volume of NAC was associated with higher pCR for TNBC and Her2 + subtypes.
INTRODUCTION: The inappropriate use of prescription opiates is a growing public-health issue in the United States. There is wellfounded concern that over-prescription may fuel abuse and dependency. We evaluated patterns of use and factors associated with discontinuation of opiates after major trauma.
Patient Experiences of Trauma Resuscitation Elinore J Kaufman, MD, Therese S Richmond, PhD, Douglas J Wiebe, PhD, Sara F Jacoby, PhD, CW Schwab, MD, Daniel N Holena, MD, FACS University of Pennsylvania, Philadelphia, PA, New YorkPresbyterian Weill Cornell, New York, NY
METHODS: The 2007e2010 military healthcare data from TRICARE database was queried for individuals 18 to 64 years of age, admitted after trauma with an Injury Severity Score (ISS) >9. Riskadjusted Cox Proportional-Hazard model was used to identify predictors of opiate-discontinuation post-discharge, with rank as a proxy for socioeconomic status (SES).
INTRODUCTION: Patient-centered care is an important aspect of quality, but is rarely assessed in an emergency context. In trauma resuscitation (TR), rapid assessment and treatment leaves little room to identify and address individual concerns. We conducted qualitative interviews and observations to assess how patients’ experiences of TR mesh with rapidly progressing clinical events.
RESULTS: Of the 7,302 individuals who met our inclusion criteria, 49% filled at least 1 opiate prescription post-discharge. 8.8% continued opiate use at 3 months, 3.8% at 6 months, and 0.9% at 1 year. In multivariate analysis, older age (45-64 years vs 18-24 years: HR¼0.84, p<0.01), being married (HR¼0.92, p¼0.01), enlisted status vs officer (Junior-Enlisted HR¼0.89, p¼0.02), and length of stay (LOS) (HR¼0.99, p<0.01) were associated with decreased likelihood of discontinuing opiate use while no differences were observed based on race, gender, ISS or diagnosis of depression or anxiety (Table).
METHODS: We conducted 30 semi-structured interviews with patients within 2 days of TR and 20 observations of video-recorded TRs at an urban, academic Level I trauma center. Data were analyzed for thematic content in NVIVO using modified grounded theory. The codebook was refined iteratively. Interrater reliability was calculated with Cohen’s kappa. RESULTS: Of interview participants, 83% were male, 70% were black, and 47% were injured in interpersonal violence. Median age was 44. Inter-rater reliability was excellent (k¼0.93). Participants’ emotional responses included fear, loss of control, and comfort. Sources of satisfaction included providers’ kindness, reassuring communication, and clinical expertise. The number and speed of providers were overwhelming, but reinforced participants’ confidence in the team’s expertise. Cutting clothing, perceptions of inexpert care, and limited or exclusionary communication contributed to dissatisfaction. Participants described altered awareness during TR, and omitted many clinical interactions and procedures seen in observations. Observations provided greater detail about providers’ communication, and of how providers used words, touch, and position to give comfort. CONCLUSIONS: Patient concerns were well aligned with clinical TR goals. However, participants’ emotions, non-clinical concerns, and dissatisfactions were rarely captured by our observations. Quality improvement in TR should address both observed and unobserved features of patient experience.
Table. Factors Associated with Discontinuation of Opiates Use up to 1 Year After Trauma Discharge Characteristic
Hazards ratio
95% CI
p Value
Age (45-64)* Race (black)** Married Rank+ Senior Enlisted Junior Enlisted Length of stay ISS (15-24)++ Anxiety Depression
0.84 1.07 0.92
0.76-0.93 0.99-1.28 0.87-0.97
<0.01 0.08 0.01
0.91 0.89 0.99 0.98 1.07 0.96
0.84-0.99 0.81-0.98 0.99-0.99 0.92-1.03 0.95-1.21 0.86-1.06
0.03 0.02 <0.01 0.43 0.24 0.44
Multivariable Cox Proportional Hazards Model adjusted for race, gender, injury severity score, diagnosis of depression and anxiety, co-morbidities, facility of care, and geographic region. a¼0.05. *Reference: 18-24, **Reference: White, +Reference: Officer, ++Reference: 9-14
CONCLUSIONS: At 3 months post-discharge, a majority of patients had discontinued opiate use. Sociodemographic factors such as advanced age, marital status and low SES were significantly associated with lower likelihood of opiate-discontinuation while