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Ali S.,Trauma Services | Brown C.V.R.,University Medical Center Brackenridge
American Surgeon | Year: 2015

The objective of this study is to compare rates of venous thromboembolism (VTE) in patients who receive enoxaparin prophylaxis compared with no enoxaparin prophylaxis after craniotomy for traumatic brain injury (TBI). This retrospective cohort evaluated all trauma patients admitted to a Level I trauma center from January 2006 to December 2011 who received craniotomy after acute TBI. Patients were excluded if developed VTE before administration of enoxaparin or they died within the first 72 hours of hospital admission. A total of 271 patients were included (enoxaparin prophylaxis, n 5 45; no enoxaparin prophylaxis, n 5 225). The median time until enoxaparin initiation was 11 6 1 days. There was no significant difference in the proportion of patients who developed a VTE when using enoxaparin prophylaxis compared with no enoxaparin prophylaxis (2 vs 4%; P 5 0.65). Rates of deep vein thrombosis (2 vs 3%; P 5 0.87) and pulmonary embolism (0 vs 1%; P 5 0.99) were similar between treatment groups, respectively. Late enoxaparin prophylaxis did not demonstrate a protective effect for VTE. Given the overall low event rate, the administration of pharmacologic prophylaxis against VTE late in the treatment course may not be routinely warranted after craniotomy for acute TBI. Further investigation with early administration of enoxaparin is needed.


News Article | February 21, 2017
Site: www.prweb.com

A clinical review just published by the American Osteopathic Association advises that misdiagnosed injuries of the foot and ankle can very well lead to arthritis, chronic pain and long term disability – all symptoms that can be avoided when injuries are properly diagnosed and treated at the outset. The study highlights the necessity of involving orthopaedic specialists to determine the severity of an injury that might otherwise be missed by frontline healthcare providers. Published in the February edition of the Journal of the American Osteopathic Association, the study by orthopedic surgeons advises caution and urges the use of additional imaging and second opinions when dealing specifically with six common foot and ankle injuries generally associated with snowboarding. They suggest that frontline healthcare providers seek opinions from an orthopaedic surgeon as misdiagnosis often results in poor long-term patient outcomes, including arthritis and disability. “This is an important point for emergency room physicians to consider,” says Mark Schakel, M.D. orthopaedic surgeon, director of the Santa Rosa Orthopaedic Foot & Ankle Program as well as Santa Rosa Memorial Hospital’s Foot and Ankle Trauma Services director. “When you’re dealing with foot and ankle injuries where symptoms can be misleading and diagnosis difficult to nail down, it’s important to go the extra mile and get a second opinion. Misdiagnosis of these types of injuries can have unfortunate consequences for the patient.” The clinical review presented by the American Osteopathic Association outlined subtleties that complicate identification and treatment specifically of snowboarder's fracture (lateral talar process fractures) as well as os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures and syndesmotic injuries. Foot and ankle injuries are more common than one might think Each year more than 3 million emergency room visits are related to common foot and ankle injuries in the U.S. They are common in people from all lifestyles including top-performing athletes as well as the more inactive among us. Statistics indicate that as many as 75 percent of Americans will experience some type of foot problem in their lifetime while about two million people are treated by orthopaedists for ankle injuries alone. No matter what the cause, injuries of the foot and/or ankle that are not accurately diagnosed or are improperly treated can lead to significant functional disability. This may affect quality of life and in some cases, impact one’s ability to accomplish everyday tasks. Analysists of the study noted that injuries related to untreated snowboarder's fractures are often associated with future arthritis, and severe pain and disability appearing years after the injury. “Improper treatment of foot and ankle traumas are commonly known to result in compensation injuries and cause other issues including tendinitis and recurrent ankle sprains,” explains Dr. Schakel. “Although some foot and ankle injuries require surgical intervention, in most cases they can be remedied with treatments including medication, immobilizing foot, applying ice and of course rest followed by physical therapy." About SRO’s Foot and Ankle Program SRO’s Orthopaedic Foot and Ankle Program provides state-of-the-art care for all types of problems related to the foot and ankle. This includes, but is not limited to, trauma of the foot and post-traumatic reconstruction of the foot and ankle, foot deformities related to neuromuscular, arthritic and congenital conditions, tendon injuries of the hind foot and ankle, sports-related injuries and foot complications of diabetes mellitus. The medical team at SRO’s Foot and Ankle program emphasizes the importance of a comprehensive evaluation to develop a proper diagnosis. Following diagnosis, the team implements the latest treatments and surgical techniques to restore function and relieve pain. To learn more visit the SRO website or call 707-546-1922.


Kothari R.U.,Western Michigan University | Kothari C.,Western Michigan University | Deboer M.,Trauma Services | Koestner A.,Spectrum Health | Rohs T.,Borgess Medical Center
Journal of Trauma and Acute Care Surgery | Year: 2014

Background: The majority of research into health care use of intimate partner violence (IPV) has focused on female victims and primarily their emergency department use. There are limited data on injury-related hospitalization rates for female victims and even less for male victims and perpetrators. The goal of this study was to determine the annualized rates of inpatient injury-related hospitalization among individuals involved as either victims or defendants in IPV. Methods: This was an observational retrospective study linking data from two Level 1 trauma centers and the county prosecutor's office from 2000 to 2010 in Kalamazoo County, Michigan. (1) Hospital data included injury-related admissions (DRG International Classification of Diseases - 9th Rev. codes 800-959.9 excluding 905-909.9). (2) Prosecutor data contained all charging requests for crimes between intimate partners. Annualized rates were calculated for the year before the IPV crime and for the year after, using the following algorithm: (number of hospitalizations) / (total population) × (per 10,000). Confidence intervals and two-sided statistical significance were calculated at the 95% confidence level. Results: During the study period, 21,179 IPV crimes were committed, involving 12,913 individual defendants and 14,797 victims. There were 30,301 injury-related hospitalizations by this group during this period. Compared with national hospitalization rates of 3.2 per 10,000 people for injury/poisoning (DRG International Classification of Diseases - 9th Rev. 800-959.9 and 990-995), IPV victim annual admission rates were 31.9, defendants at 90.4, and bidirectional individuals at 339.1 per 10,000 people, in the 2 years surrounding the crime. Males, regardless of crime role, have higher injury-related hospitalization rates in this period compared with females (male, 115.6; female, 41.8). Males (victims or defendants) and bidirectional participants of either sex had rates that were significantly higher the year after than the year before the crime. Conclusion: Individuals involved in IPV have a 10-fold higher injury-related hospitalization rate as compared with age-matched national rates. Admission rates vary by sex, crime role, and time frame, with males and bidirectional participants having the highest rates. Copyright © 2014 Lippincott Williams & Wilkins.


Harvey E.M.,Trauma Services | Wright A.,Trauma Services | Taylor D.,Carilion Roanoke Memorial Hospital | Bath J.,Carilion Roanoke Memorial Hospital | Collier B.,Virginia Polytechnic Institute and State University
Journal of Continuing Education in Nursing | Year: 2013

Initial assessment and treatment of critically injured patients is time sensitive, creating a high-stress environment for trauma team members and patients. Effective leadership, communication, and clinical acumen are essential team dynamics for best patient outcomes. Innovative multidisciplinary Team STEPPS® simulation-based training is an effective model for teams in high-risk health care settings. Use of this simulation model has led to improved trauma team performance and patient outcomes while incorporating new physician and nursing personnel into a time-sensitive, high-stress environment. © SLACK Incorporated.


Capella J.,Virginia Polytechnic Institute and State University | Smith S.,Virginia Polytechnic Institute and State University | Philp A.,Virginia Polytechnic Institute and State University | Putnam T.,Virginia Polytechnic Institute and State University | And 8 more authors.
Journal of Surgical Education | Year: 2010

Objectives: We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes? Design: This intervention study used a pretraining/ posttraining design. The intervention was TeamSTEPPS augmented by simulation. The evaluation instrument, which was the Trauma Team Performance Observation Tool (TPOT), was used by trained evaluators to assess teams' performance during trauma resuscitations. From November 2008 to February 2009, a convenience sample (n = 33) of trauma resuscitations was evaluated. From February to April 2009, team training was conducted. From May to July 2009, another sample (n = 40) of resuscitations were evaluated. Clinical data were gathered from our trauma registry. The clinical parameters included time from arrival to computed tomography (CT) scanner, arrival to intubation, arrival to operating room, arrival to Focused Assessment Sonography in Trauma (FAST) examination, time in emergency department (ED), hospital length of stay (LOS), intensive care unit LOS, complications, and mortality. Comparing pretraining and posttraining resuscitations, we calculated means, standard deviations, and p values for teamwork ratings and clinical parameters, and we determined significance using the independent samples t-test. Setting: Level I Trauma Center. Participants: The trauma team included surgery residents, faculty, and nurses. Results: Our trauma team showed significant improvement in all teamwork domain ratings and overall ratings from pretraining to posttrainingleadership (2.87-3.46, p = 0.003), situation monitoring (3.30-3.91, p = 0.009), mutual support (3.40-3.96, p = 0.004), communication (2.90-3.46, p = 0.001), and overall (3.12-3.70, p < 0.001). The times from arrival to the CT scanner (26.4-22.1 minutes, p = 0.005), endotracheal intubation (10.1-6.6 minutes, p = 0.49) and the operating room (130.1-94.5 minutes, p = 0.021) were decreased significantly after the training. Conclusions: Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (ATLS). © 2010 Association of Program Directors in Surgery.


RumbleLab, Kitchen Conversations by Sexual Trauma Services of the Midlands and Bonded to compete Wednesday night for $5000 sponsored by Nephron Pharmacueticals

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