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Potentially Preventable Pre-Hospital Deaths from Motor-Vehicle Collisions
S166
Scientific Forum Abstracts
INTRODUCTION: Older adults are the fastest-growing trauma population. At time of injury, most are living independently, but only 50% are discharged directly home. It is unclear how many patients return home or the level of recovery achieved. The aim of this study was to evaluate the functional recovery of the injured elderly over 6 months. METHODS: Data were prospectively collected on patients 55 years old, admitted to a level 1 trauma center after a traumatic event (eg, fall). Data included demographics, injury characteristics, and hospital course. A self-reported physical function measure (PROMIS-PF) was administered on admission, immediately post-discharge, and at 3 and 6 months post-injury to evaluate physical function. The PROMIS-PF score ranges from 20 to 100, and the minimally important difference is 4.0-6.0. RESULTS: There were 146 enrolled patients; 10 withdrew and 6 died. Follow-up rates were 41.1% at 3 months and 39.7% at 6 months. Median age was 64 years. Fall was the leading mechanism of injury (86.0%). Of those sustaining injury (33% did not), the mean Injury Severity Score was 5(4.5) and the majority (27.2%) had a primary orthopaedic injury. Of those discharged alive, 39.6% were discharged home, 25.3% to a skilled nursing facilty, and 4% to rehabilitation. On average, PF scores decreased by 10(16.6) points immediately post-discharge. At 6 months, PF scores were, on average, only 2(15.5) points less than pre-injury and 84.6% had returned home. CONCLUSIONS: Injured older adults suffer functional decline. However, the majority experience near-complete recovery and return home by 6 months. Further work is needed to evaluate the effect of injury pattern and discharge disposition on recovery after traumatic injury. Potentially Preventable Pre-Hospital Deaths from MotorVehicle Collisions Juliet J Ray, MD, Shevonne S Satahoo, MD, James S Davis, MD, Harrison Dermer, Katherina Julien, Robert M Van Haren, MD, MSPH, Jill Graygo, MPH, Lorne H Blackbourne, MD, FACS, George T Bahouth, Carl I Schulman, MD, PhD, FACS University of Miami, Miami, FL INTRODUCTION: In 2012, an estimated 34,000 people died in motor vehicle collisions (MVC) in the United States. We sought to evaluate the causes of pre-hospital deaths related to MVCs, and to assess whether these deaths were potentially preventable. METHODS: Medical examiner records for 2011 were reviewed for all MVC pre-hospital deaths. Injuries were categorized by affected organ and anatomic location of the body. Cases were reviewed by a panel of trauma surgeons to determine cause of death, and whether the death was potentially preventable. Time to death and hospital arrival times
J Am Coll Surg
were established using the Fatality Analysis Reporting System (FARS) data from 2002-2012 to establish national prevalence estimates. RESULTS: Thirty-nine percent of the 98 deaths reviewed were potentially preventable (PPD). Significantly more patients with PPD had neurotrauma as a cause of death compared with those with a non-preventable death (NPD) (44.7% vs 25.0%, p¼0.049). The NPDs were significantly more likely to have combined neurotrauma and hemorrhage as cause of death compared with PPDs (45.0% vs 10.5%, p<0.001). Non-preventable deaths were significantly more likely to have injuries to the chest, pelvis, or spine. NPDs also had significantly more injuries to the following organ systems: lung, cardiac, and vascular chest (all p<0.05). FARS data demonstrated 30% of deaths occurred on scene and another 32% occurred within 1 hour of injury. CONCLUSIONS: Nationally, almost two-thirds of all MVC deaths occurred within 1 hour of injury. More than one-third of pre-hospital MVC deaths were potentially preventable. By examining injury patterns in PPDs, targeted intervention may be initiated. Predicting Mortality in the Geriatric Patient after Blunt Traumatic Hemorrhagic Shock John O Hwabejire, MD, Christine E Nembhard, MD, Edward E Cornwell III, MD, FACS, Suryanarayana M Siram, MD, FACS, Wendy R Greene, MD, FACS Howard University Hospital, Washington, DC INTRODUCTION: There are sparse data on mortality after traumatic hemorrhagic shock in the elderly and as such, patients and caregivers have little objective guidance for clinical decision making and end-of-life-care. We explored the factors that predict mortality in severely injured elderly patients in hemorrhagic shock. METHODS: The Glue Grant database was examined. All elderly patients (aged 65 years and above) were identified, with survivors compared with non-survivors. Univariate and multivariable analyses were used to determine predictors of in-hospital mortality. RESULTS: Of 1,976 patients, 289 (14.6%) were elderly. Compared with all-comers with in-hospital mortality of 16.0%, that of the elderly was 30.4% (p<0.001). Among the elderly, survivors were younger (74 7 y vs 78 7 y, p<0.001), had higher BMI (27.8 7.9 vs 24.7 10.1 kg/m2, p¼0.006), higher platelet count (103 37 vs 84 35, p¼0.001), and lower emergency room (ER) lactate (3.8 2.3 vs 5.6 3.4, p<0.001), maximum lactate (3.3 2.0 vs 5.0 3.6, p<0.001), APACHE II score (30.5 7.5 vs 36.4 7.0, p<0.001), Injury Severity Score (28 13 vs 36 15, p<0.001), and volume of transfused blood (2,040 2,033 mL vs 3,908 3,550 mL, p<0.001) than non-survivors. Also, survivors were less likely to be on pre-injury calcium-channel blockers (6.0% vs 14.8%, p¼0.014), less likely to undergo a laparotomy (28.4% vs 53.4%, p<0.001), and less likely to have a cardiac arrest (3.5%
Scientific Forum Abstracts
INTRODUCTION: Older adults are the fastest-growing trauma population. At time of injury, most are living independently, but only 50% are discharged directly home. It is unclear how many patients return home or the level of recovery achieved. The aim of this study was to evaluate the functional recovery of the injured elderly over 6 months. METHODS: Data were prospectively collected on patients 55 years old, admitted to a level 1 trauma center after a traumatic event (eg, fall). Data included demographics, injury characteristics, and hospital course. A self-reported physical function measure (PROMIS-PF) was administered on admission, immediately post-discharge, and at 3 and 6 months post-injury to evaluate physical function. The PROMIS-PF score ranges from 20 to 100, and the minimally important difference is 4.0-6.0. RESULTS: There were 146 enrolled patients; 10 withdrew and 6 died. Follow-up rates were 41.1% at 3 months and 39.7% at 6 months. Median age was 64 years. Fall was the leading mechanism of injury (86.0%). Of those sustaining injury (33% did not), the mean Injury Severity Score was 5(4.5) and the majority (27.2%) had a primary orthopaedic injury. Of those discharged alive, 39.6% were discharged home, 25.3% to a skilled nursing facilty, and 4% to rehabilitation. On average, PF scores decreased by 10(16.6) points immediately post-discharge. At 6 months, PF scores were, on average, only 2(15.5) points less than pre-injury and 84.6% had returned home. CONCLUSIONS: Injured older adults suffer functional decline. However, the majority experience near-complete recovery and return home by 6 months. Further work is needed to evaluate the effect of injury pattern and discharge disposition on recovery after traumatic injury. Potentially Preventable Pre-Hospital Deaths from MotorVehicle Collisions Juliet J Ray, MD, Shevonne S Satahoo, MD, James S Davis, MD, Harrison Dermer, Katherina Julien, Robert M Van Haren, MD, MSPH, Jill Graygo, MPH, Lorne H Blackbourne, MD, FACS, George T Bahouth, Carl I Schulman, MD, PhD, FACS University of Miami, Miami, FL INTRODUCTION: In 2012, an estimated 34,000 people died in motor vehicle collisions (MVC) in the United States. We sought to evaluate the causes of pre-hospital deaths related to MVCs, and to assess whether these deaths were potentially preventable. METHODS: Medical examiner records for 2011 were reviewed for all MVC pre-hospital deaths. Injuries were categorized by affected organ and anatomic location of the body. Cases were reviewed by a panel of trauma surgeons to determine cause of death, and whether the death was potentially preventable. Time to death and hospital arrival times
J Am Coll Surg
were established using the Fatality Analysis Reporting System (FARS) data from 2002-2012 to establish national prevalence estimates. RESULTS: Thirty-nine percent of the 98 deaths reviewed were potentially preventable (PPD). Significantly more patients with PPD had neurotrauma as a cause of death compared with those with a non-preventable death (NPD) (44.7% vs 25.0%, p¼0.049). The NPDs were significantly more likely to have combined neurotrauma and hemorrhage as cause of death compared with PPDs (45.0% vs 10.5%, p<0.001). Non-preventable deaths were significantly more likely to have injuries to the chest, pelvis, or spine. NPDs also had significantly more injuries to the following organ systems: lung, cardiac, and vascular chest (all p<0.05). FARS data demonstrated 30% of deaths occurred on scene and another 32% occurred within 1 hour of injury. CONCLUSIONS: Nationally, almost two-thirds of all MVC deaths occurred within 1 hour of injury. More than one-third of pre-hospital MVC deaths were potentially preventable. By examining injury patterns in PPDs, targeted intervention may be initiated. Predicting Mortality in the Geriatric Patient after Blunt Traumatic Hemorrhagic Shock John O Hwabejire, MD, Christine E Nembhard, MD, Edward E Cornwell III, MD, FACS, Suryanarayana M Siram, MD, FACS, Wendy R Greene, MD, FACS Howard University Hospital, Washington, DC INTRODUCTION: There are sparse data on mortality after traumatic hemorrhagic shock in the elderly and as such, patients and caregivers have little objective guidance for clinical decision making and end-of-life-care. We explored the factors that predict mortality in severely injured elderly patients in hemorrhagic shock. METHODS: The Glue Grant database was examined. All elderly patients (aged 65 years and above) were identified, with survivors compared with non-survivors. Univariate and multivariable analyses were used to determine predictors of in-hospital mortality. RESULTS: Of 1,976 patients, 289 (14.6%) were elderly. Compared with all-comers with in-hospital mortality of 16.0%, that of the elderly was 30.4% (p<0.001). Among the elderly, survivors were younger (74 7 y vs 78 7 y, p<0.001), had higher BMI (27.8 7.9 vs 24.7 10.1 kg/m2, p¼0.006), higher platelet count (103 37 vs 84 35, p¼0.001), and lower emergency room (ER) lactate (3.8 2.3 vs 5.6 3.4, p<0.001), maximum lactate (3.3 2.0 vs 5.0 3.6, p<0.001), APACHE II score (30.5 7.5 vs 36.4 7.0, p<0.001), Injury Severity Score (28 13 vs 36 15, p<0.001), and volume of transfused blood (2,040 2,033 mL vs 3,908 3,550 mL, p<0.001) than non-survivors. Also, survivors were less likely to be on pre-injury calcium-channel blockers (6.0% vs 14.8%, p¼0.014), less likely to undergo a laparotomy (28.4% vs 53.4%, p<0.001), and less likely to have a cardiac arrest (3.5%