Trauma Commons^™

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

A Nurse-Driven Escalation In Trauma Team Activation Reduces Mortality Of Injured Patients, Darrell L. Hunt, Yingxian Liu, Jordan S. Rahm, Bailey Segura, Mercedes Huens, Emily Lopez, Esther Krinsky, Joe Spinell, Andrea Palmer

HCA Healthcare Journal of Medicine

Background

There is a dearth of literature examining the clinical outcomes of injured patients who experience physiological deterioration in the emergency department (ED). At our trauma center, injured patients who develop hemodynamic, respiratory, or mental status instability after arrival are retriaged and upgraded to a full trauma team activation (fTA). The purpose of this study was to compare the clinical outcomes of patients with fTA based on prehospital signs and symptoms (initial) versus upgraded fTA patients.

Methods

This was a single-center, retrospective cohort study of injured patients presenting to a tertiary trauma center between June 1, 2022, and June 30, …

Brief, Handoff, Backbrief, Forecast, Review: A Communication Cycle For Safer Trauma And Surgical Intensive Care Unit Transitions, Constantine Stephens, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Safety in trauma and surgical critical care is inseparable from the reliability of communication at transitions of care. Handoffs are recurrent, high-risk moments in which teams transfer not only information but responsibility, prioritization, uncertainty, and contingency planning; failures at these points propagate into omissions, delayed escalation, and preventable harm to patients and strain on the workforce. Structured handoff tools improve completeness and clarity but inconsistently change hard clinical endpoints, and tools alone do not create the culture of safety on which high-reliability organizations (HROs) depend. This narrative review synthesizes civilian handoff research, human-factors and HRO theory, situation-awareness, psychological safety, trauma …

Impact Of Pre-Existing Psychiatric Conditions On Trauma Outcomes: A National Analysis, Kelly Mckenney, Marie Ugo, Sindhura Kompella, Clara Alvarez, Ilko Luque

HCA Healthcare Journal of Medicine

Background

Understanding the impact of psychiatric pre-existing conditions (PsyPECs) on trauma outcomes is crucial, as trauma is the leading cause of mortality for Americans aged 1-45. Although previous regional studies have shown higher mortality rates and longer hospital length of stay (H-LOS) for injured patients with PsyPECs, this has not been studied at the national level. The purpose of this study is to identify the PsyPECs associated with mechanism of injury and other outcomes in adult patients admitted for trauma in the United States’ trauma centers.

Methods

Data were extracted from the National Trauma Data Bank (NTDB). There were 5301 …

Exploring The Effects Of Traumatic Brain Injuries On Cranial Nerve Injury, Caitlin J. Mcpartland, Michael J. Pienkos, Sarah E. Johnson, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Background

Traumatic brain injuries (TBI) are a significant and growing health issue, leading to over 200 000 hospitalizations annually in the United States. Cranial nerve (CN) injuries accompanying TBI can severely impact patients’ quality of life. This review aims to address the gap in research regarding the severity, mechanisms of injury, and associated intracranial injuries, emphasizing the importance of early detection and intervention.

Methods

A comprehensive literature search was conducted across databases such as PubMed and Ovid using key terms, including “cranial nerve injury,” “cranial nerve palsy,” “traumatic brain injury,” and “Glasgow Coma Scale.” Inclusion criteria encompassed studies reporting CN …

Portable Head Computed Tomography Protocol For Trauma, Christian Quinones, Alexander Bolufer, Cory Hewitt, Sagun Tuli

HCA Healthcare Journal of Medicine

The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols …

Risk Factors Associated With Worse Outcomes In Trauma Patients Aged 55 And Older, Hector Mendez, Ilko Luque, Nicole Yordán López, Carlos Parra, Kelvin Chan, Mariel A. Javier, Marcela Ramirez, Orlando Morejón

HCA Healthcare Journal of Medicine

Background

Prior studies have shown an increase in mortality in trauma patients after 55 years of age. However, it is less certain which pre-existing comorbidities (PECs) are associated with poorer outcomes. The purpose of this study was to identify the risk factors associated with poor outcomes and death in patients 55 years old and older admitted for trauma.

Methods

Trauma patients (age ≥ 55) were studied retrospectively from the local trauma registry at HCA Florida Kendall Hospital, a level 1 trauma center (2020–22). We collected the subject’s age, gender, PECs, and outcome data. Then we performed multiple logistic regression to …

Endovascular Repair Of A Superior Mesenteric Arteriovenous Fistula And Pseudoaneurysm After A Single Gunshot Wound To The Abdomen, Robert Ringersen Iii, Michael Shockley, Sanjiv Gray, Tracy Bilski, Julio Calderin, Philip Kondylis

HCA Healthcare Journal of Medicine

Background

Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case Presentation

A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was …

Inpatient Falls: Epidemiology, Risk Assessment, And Prevention Measures. A Narrative Review, Taylor Locklear, Jeannie Kontos, Callaham A. Brock, Alexander B. Holland, Rachel Hemsath, Anna Deal, Shannon Leonard, Carsten Steinmetz, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such …

Rare Right-Sided Posterolateral Diaphragmatic Hernia In An Adult Presenting As An Incarcerated Large Bowel Obstruction: A Case Report, Tanya J. T. Starr, Andrew G. Nicholson, Maximillian J. H. Starr, Jessica A. Traxler, Peter Y. Chu

HCA Healthcare Journal of Medicine

Introduction

A diaphragmatic hernia (DH) is a defect within a part of the diaphragm that allows intra-abdominal contents to enter the thoracic cavity. Diaphragmatic hernias can be congenital or acquired later in life. The most common congenital DH is the Bochdalek hernia (posterolateral hernia), but the most commonly acquired DH is due to traumatic injury. These hernias are rare in adults and are typically diagnosed incidentally. Surgical repair is the standard of care; however, data regarding the surgical approach is scarce. We report a case of a rare right posterolateral DH in an adult female patient who presented with acute …

How Did That Get There? A Case Series Of Adolescent Foreign Bodies, Justin Ian Hanson, Paul Bomar, Sarah Kleist, Denver Rogalla, Lori Crihfield, Scott Gutovitz

HCA Healthcare Journal of Medicine

Introduction

Pediatric foreign bodies (FBs) come in many shapes and sizes, and the method by which they enter the body can greatly impact the level of acuity at presentation. Most FBs in children are found in those younger than 5 years old, but the following 3 cases were found in adolescent patients.

Case Presentation

We report on 3 adolescent patients who presented to a single community-based emergency department with the chief complaint of abdominal pain and were found to have complications of abdominal FBs. If undiagnosed, the initial indolent courses of FBs can lead to serious complications, as shown in …

Car Ratings Take A Back Seat To Vehicle Type: Outcomes Of Suv Versus Passenger Car Crashes, Dietrich Jehle, Albert Arslan, Chirag Doshi, Clay O'Brien

HCA Healthcare Journal of Medicine

Background

Car safety ratings are routinely utilized in making automobile purchase decisions. These 1- to 5-star ratings are based on crash test data comparing vehicles of similar type, size and weight.

Objectives

We hypothesized that car safety ratings are less important than vehicle factors such as vehicle type and weight in predicting outcomes of head-on crashes.

Methods

A retrospective study was conducted on severe head-on motor vehicle crashes entered into the FARS (Fatality Analysis Reporting System) database between 1995 and 2010. This database includes all US motor vehicle crashes that resulted in a death within 30 days of the accident. …

Trauma Recidivism In An Aging Population: Who Is Most At Risk?, Ryan Taylor, Austin Mccrea, Nayda Parisio Poldiak, Keely Muertos, Saptarshi Biswas, Christoph Kaufmann

HCA Healthcare Journal of Medicine

Background

Repeated episodes of trauma, particularly in older adults, result in increased morbidity and mortality. This study investigates trauma recidivism in our adult population to identify which patients in our region are more likely to become recidivists.

Materials and Methods

This 4 year retrospective study (2013 to 2017) examines all patients 18 years of age or older with multiple hospital admissions for trauma, comparing patients ages 65 and older (older adults) to those ages 18 to 64 (younger adults). Exclusion criteria consisted of those younger than 18 and/or had a home zip code outside of the study region. Data included …