- Factors Affecting the Delay of a Decision to Admit Severe Trauma Patients and the Effect of a Multidisciplinary Department System: a Preliminary Study
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Mun Ju Kang, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Hyoung Gon Song
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J Korean Soc Traumatol. 2010;23(2):113-118.
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 Abstract
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- PURPOSE
Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision.
METHODS
A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system.
RESULTS
A total of 89 patients were enrolled. The average time from triage to the admission decision was 5.2+/-7.1 hours and the average length of the ED stay was 9.0+/-11.5 hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was 2.1+/-1.5 hours.
CONCLUSION
In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.
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Summary
- The Relationship between Facial Fractures and Radiologically-proven Cranial Injuries
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Jin Woo Song, Ik Joon Jo, Sang Kook Han, Yeon Kwon Jeong
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J Korean Soc Traumatol. 2009;22(1):18-23.
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Abstract
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- PURPOSE
In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries.
METHODS
Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs.
RESULTS
Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures.
CONCLUSION
Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.
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