Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States

Objective

To compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults.

Data Sources and Study Setting

We used claims of 100% of 2012–2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma.

Study Design

Survival differences were estimated after applying propensity-score-based overlap weights. Subgroup analyses were performed for ambulance-transported patients and by external cause. We assessed the roles of prehospital care, hospital quality, and volume.

Data Collection

Data were obtained from the Centers for Medicare and Medicaid Services.

Principal Findings

Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 (95% confidence interval [CI]: 1.8, 2.6) percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 (95% CI: 1.9, 2.8) pp for falls and 2.3 (95% CI: 0.2, 4.4) pp for motor vehicle crashes. Differences persisted at 1 year. Level 1 and 2 trauma centers had similar outcomes. Hospital quality and volume did not explain these differences. In the ambulance-transported subgroup, after adjusting for prehospital variables, no statistically significant differences remained.

Conclusions

Trauma centers may not provide longer survival than similarly sized non-trauma hospitals for severely injured older adults.     

以颅脑损伤为主的多发伤急救中心一体化救治探讨(附148例报道)

目的探讨以颅脑损伤为主的多发伤急救中心一体化救治的意义及重要措施。方法回顾性分析2002年11月~2006年2月收治的148例颅脑损伤合并多发伤患者的临床资料。结果死亡26例,植物生存状态7例,重残17例,轻残26例,痊愈72例。结论颅脑损伤合并多发伤往往伤情严重,变化快。此类患者必须由急救中心医师组织实施救治,边抢救边诊断。首先处理危及生命的损伤,及时纠正休克,是抢救成功的关键。手术时机的选择,尤其是行多发伤一期手术,脏器功能的监测和保护,注意营养支持,是提高抢救成功率的重要措施,而且急诊ICU在多发伤救治中起到重要作用。     

从颅脑外伤救治中存在的问题谈区域创伤中心建设的重点

目的 结合目前国内在颅脑外伤救治中存在的问题探讨区域创伤中心建设的重点内容及关注点。方法 收集2015年8月至2017年7月泰州市人民医院收治的颅脑外伤急诊手术病例共171例。根据患者入院时GCS评分（Glasgow Coma Scale）分为4组。术后根据其出院时的GCS评分对其预后进行评价,分为死亡,4～5分,6～8分,9～12分,13～15分5个类别。结果 共有171例患者纳入本研究中,按照入院GCS评分分为4组（3～5分,6～8分,9～12分,13～15分）,其病死率分别是48.15%,20.59%,4.76%,8.57%。在3～5分组中入院1 h内手术的组内死亡率与1～2 h及大于2 h相比（17.95%,38.96%,43.59%）差异有统计学意义（P<0.05）,在6～8分组入院1 h内手术的组内死亡率与1～2 h及大于2 h相比（0,42.86%,57.14%）差异有统计学意义（P<0.05）,另外两组（9～12分,13～15分）死亡率组间比较差异无统计学意义（P>0.05）。针对上述数据,结合国内及国际颅脑创伤救治现状分析,目前颅脑外伤救治中存在院前...     

Assessment of procedural pain in French emergency departments: a multi-site,non-interventional,transverse study in patients with minor trauma injury

ABSTRACT

Objective: To determine the mean number of procedural painful episodes per patient, and to retrieve information regarding diagnosis, therapeutic procedures and analgesic management, in patients visiting Emergency Departments (EDs) for minor trauma.

Methods: This observational, non-interventional, multicenter study in adult patients was performed in 35 French EDs. All patients entering the EDs for minor trauma on a specified day between noon and 10 pm were registered; consenting patients were included in the study. Pain intensity was assessed using a verbal Numerical Rating Scale from 0 (no pain) to 10 (worst possible pain). An episode was described as painful if the difference in pain intensity between pain just before the procedure and maximal pain during the procedure was ≥2. Two independent nurses recorded data on 1 day in each center.

Results: Overall, 909 patients were registered, 422 were included in the study, and complete data for 409 patients (1899 procedures) were available for analysis. The mean number of painful episodes per patient was 1.0 ± 1.3. Fifty-one percent of patients reported at least one painful procedure episode. Twenty-one percent of procedures were considered painful. Clinical examination was the procedure most often reported as painful. No preventive or curative analgesic treatment was reported in 95.1% of procedures.

Conclusions: There is a need for improvement in routine pain assessment and, therefore, procedural pain management for ED patients. Specific protocols should be developed for procedural pain management, and teams should be trained especially for procedures usually not considered painful.     

124例牙外伤急诊临床分析

目的探讨急诊牙外伤的临床特点,为牙外伤的防护和应急处理提供参考。方法对该院2011年3月—2013年3月收治的124例牙外伤急诊患者进行临床分析。结果 124例患者中,男女比例为1.70∶1。外伤时间春季较少,冬季较多;周末较平时增加。外伤牙受伤牙位左右基本对称,上中切牙最易受累。各类型牙外伤中,冠折为最多见。大部分患者在牙外伤后24h内到急诊就诊。结论应针对牙外伤的发病原因、地点、人群、好发季节、好发牙位等采取相应的预防措施,有效避免牙外伤的发生。     

Trauma-informed supervision: Counselors in a Level I hospital trauma center

ABSTRACT

Trauma-informed counseling has increased in scope, including work in acute care hospital settings. In this article, we examine trauma-informed supervision, with particular attention to its implementation in a Level I hospital trauma setting involving specialized interventions at the bedside with severely injured trauma patients. Issues of supervision pertaining to substance use and post-traumatic stress response are emphasized. A case example is presented to demonstrate the unique needs of clinicians in an acute care hospital setting and the trauma-informed supervision practices we use with clinicians. Finally, we make recommendations for supervisors in acute care hospital settings and other similar settings.     

舒适护理在重症监护病房气管切开患者护理中的效果观察

目的 观察舒适护理对ICU病房内气管切开患者的护理效果。方法 选取了自2015年6月—2016年11月在本院ICU病房住院并接受气管切开术治疗的77名患者,根据患者住院时间的不同,将患者分为2组。2015年6月—2016年2月住院的患者纳入对照组接受常规护理干预;而2016年3月及以后住院的患者纳入实验组,予以舒适护理。比较2组患者住院期间气管切开术并发症的发生情况。采用焦虑自评量表和忧郁自评量表对患者住院期间的焦虑及忧郁情绪进行打分,比较两组间的差异。另外,患者出院后采用自制的问卷对住院期间护理的满意度和舒适度进行评定。结果 实验组患者术后并发症的发生率低于对照组。其中脱管、皮下气肿和气道出血的发生率两组差异无统计学意义(P>0.05),肺部感染的发生率差异有统计学意义(P<0.05)。实验组患者焦虑自评量表评分和忧郁自评量表评分均显著低于对照组,差异有统计学意义(P<0.05)。实验组患者对住院期间护理工作的舒适度评分和满意度评分均明显高于对照组,差异有统计学意义(P<0.05)。结论 舒适护理能在一定程度上降低ICU病房气管切开患者的术后并发症发生率,缓解患者住院期间焦虑、抑郁等不良情绪,提高护理满意度和舒适度,值得进一步推广和应用。     

营养支持在外科多发性创伤中的应用

目的：观察１５例多发性伤病人营养支持的治疗效果。方法：随机选择１５例病人,经过约２周营养支持并观察血糖、血脂、电解质、肝功能及胆红素的变化。结果：营养支持对多发性创伤病人至关重要,对病人切口,骨折的愈合,全身营养状况的改善起到良好的作用。结论我们主茇ＰＮ为主,一旦肠蠕动恢复后,及时过渡到ＥＮ,以减少肠道细菌和内毒素易位,减少并发症的发生。     

Sensory processing relates to attachment to childhood comfort objects of college students

The author tested the hypothesis that attachment to comfort objects is based on the sensory processing characteristics of the individual. Fifty-two undergraduate students with and without a childhood comfort object reported sensory responses and performed a tactile threshold task. Those with a comfort object described their object and rated their attachment to it. Participants with a strong attachment liked the texture of their comfort object and sleeping with it. Smell sensitivity in childhood, seeking out tactile stimulation as children, and tactile threshold predicted the intensity of object attachment. Participants with comfort objects showed a higher tactile threshold and reported seeking out more tactile stimulation as children than participants without a comfort object did. These findings suggest that children with an object attachment seek out more sensory stimulation through touch, which in turn is soothing. Results support growing research linking sensory processing to psychological functioning.     

Audit in clinical practice: evaluating use of a nutrition screening tool developed for trauma nurses

Background: The Nutrition Checklist screening tool was developed by dietitians for the trauma nursing staff at the John Radcliffe Hospital, Oxford. Its purpose was to identify those at nutritional risk so that dietetic assessment and intervention could be implemented. This paper focuses on a single day audit that was devised 5 months post-initiation of the Nutrition Checklist. Method: Data from 48 nursing care plans was used to measure compliance of recording a nutrition score (and re-scoring where applicable) alongside the timing of dietetic referral and intervention. Results: Sixty-seven per cent (32/48) of trauma patients had a nutrition score recorded, however only 75% (24/32) of these patients were scored within 24 h of admission. Of those due for reassessment, only 38% (11/29) were rescored. Eighty-eight per cent (23/26) of the patients who scored ≥ 3 (automatic referrals) were referred to the dietitian; the dietitian documented 100% (23/23) of referrals. Conclusion: The audit suggests limited use of the screening tool by nurses. Collaboration between the nursing team, dietitian, consultant team, catering and clinical auditors could improve compliance in the use of the Nutrition Checklist and ultimately lead to improved clinical practice in nutritional care delivery. Despite its limitations, the audit exercise was a valuable learning experience in the maintenance of a nursing Nutrition Checklist. Further research is needed to assess whether the introduction of such a screening tool improves patient outcomes by minimizing nutrition-related complications.     

舒适护理对老年慢性阻塞性肺气肿患者生活质量和舒适度的影响效果观察

目的 观察对老年慢性阻塞性肺气肿患者进行舒适护理后的生活质量与舒适度的影响效果。 方法 选取2017年5月—2018年4月收治的老年慢性阻塞性肺气肿患者80例,随机分组,实验组40例进行舒适护理,对照组40例进行一般护理。比较2组根据护理前后舒适度与生活质量。 结果 2组患者护理后,实验组生活质量评分高于对照组,实验组舒适度为95.0%,高于对照组的77.5%,护理效果显著(P<0.05)。 结论 对老年慢性阻塞性肺气肿患者应用舒适护理干预,可以缓解患者身体不适情况,提高患者的舒适度与生活质量,具有临床推广价值。     

重庆市大足区某急救创伤中心收治的创伤病例院前特征分析

目的 分析重庆市大足区某急救创伤中心收治的创伤病例的院前流行病学特征,为合理配置院前急救资源、提高创伤救治水平提供客观依据.方法 收集2015-2019年重庆市大足区某急救创伤中心的院前创伤病例资料,并对其特征进行分析.结果 共纳入创伤病例20 129例,跌倒伤为主要创伤种类,占32.32％,其次是交通伤,占29.35...     

标准外伤大骨瓣减压术与常规骨瓣减压术治疗严重对冲性颅脑损伤的临床对比研究

目的评价标准外伤大骨瓣减压手术治疗严重对冲性颅脑损伤的疗效。方法32例脑疝形成的对冲性颅脑损伤患者采用标准外伤大骨瓣开颅内外减压手术治疗,并与同期收治的24例常规骨瓣开颅手术组进行比较,分析其疗效。结果标准外伤大骨瓣减压手术治疗组32例中,恢复良好21例(占65.6%),死亡5例(占15.6%);常规骨瓣开颅手术组24例中,恢复良好9例(占37.5%),死亡10例(占41.7%)。2组对比,恢复良好率和死亡率差异有统计学意义(P<0.05),标准外伤大骨瓣减压手术治疗组预后明显优于常规骨瓣开颅手术组。结论标准外伤性大骨瓣内外减压手术能明显改善严重对冲性颅脑损伤病人的预后,并降低死亡率。     

玻璃体手术在各类眼底病变中应用的临床分析

目的评价玻璃切除术在玻璃体、视网膜疾病及眼外伤治疗中的效果。方法对137例玻璃体切除术病例进行回顾性分析。结果术后视力提高113例（82．5％）,术后发生视网膜脱离10例（7．3％）。结论玻璃体切除术是治疗玻璃体、视网膜疾病、眼外伤的有效方法。     

卧姿 人体全身振动暴露的舒适性评价与应用

通过１３人三百多人次的卧姿振动实验，得到了卧姿人体全身振动暴露１ｍｉｎ降低舒适性的阈限；据此导出了１６ｍｉｎ、２５ｍｉｎ、１ｈ、２．５ｈ、４ｈ、８ｈ、１６ｈ２４、ｈ对应的降低舒适性界限；建立了相应的舒适性评价方法；用于某野战急救车的乘卧舒适性评价，取得了较好的效果。     

大城市区域性创伤急救网络在危重伤员救治中的作用

目的 研究区域性创伤急救网络在严重创伤伤员救治中的作用.方法收集2005年3月-2007年10月间进入我院急诊抢救室的1421例伤员的资料,根据是否为网络内单位伤员分为网络组和非网络组.比较和分析两组伤后至就诊的时间间隔、致伤原因、送院工具及通讯联络、院前及院内处置.结果 网络组1h内入院明显高于非网络组.网络组伤员送院前417例(89%)有预报.非网络组108例(13%)120送院前有预报.结论 区域性创伤急救网络在严重创伤伤员的救治中具有重要作用.     

颅脑外伤患者血糖水平的监测及其意义

目的 探讨颅脑外伤患者血糖水平监测的意义.方法 共纳入69例颅脑外伤患者,按GCS评分分为轻中重3组,3组患者均于入院时抽取静脉血检测血糖.从入院d2开始,每天至少1次检测血糖,每周取平均值,共监测3周.并比较恢复良好组、遗留残疾组及死亡组的入院血糖及3周的血糖.结果 GCS评分3组患者中,中度组及重度组两组患者的入院血糖明显高于轻度组患者;与中度组相比,重度组患者血糖均明显增高.在预后的3组患者中,遗留残疾组及死亡组两组患者的血糖均明显高于恢复良好组患者;与遗留残疾组相比,死亡组患者的血糖均明显增高.结论 颅脑外伤患者的血糖水平可以反映患者的病情严重程度,且可以显著影响患者的预后情况,因此对该类患者早期行降血糖治疗可以降低患者的死亡率,提高患者的预后生存质量.     

高压氧综合治疗颅脑损伤的护理

目的：探讨高压氧治疗颅脑损伤的护理在治疗中的作用。方法：对106例高压氧治疗患者进行治疗前、中、后的护理。结果：106例患者无一例出现护理并发症及意外。结论：通过对治疗中患者的护理,减少了并发症的发生,提高了治疗效果,适合于高压氧的治疗。