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Download Poster Abstracts Poster # 1 Failure to Rescue and the Weekend Effect: A Study of a Statewide Trauma System Catherine E. Sharoky MD, Morgan M. Sellers MD, Elinore J. Kaufman MD, MSHP, Yanlan Huang MS, Wei Yang Ph.D., Rachel R. Kelz MD, MSCE, Patrick M. Reilly* MD, Daniel N. Holena* MD, MSCE University of Pennsylvania Introduction: Differential patient outcomes based on weekday or weekend patient presentation (i.e. the “weekend effect”) have been reported for several disease states. Failure to rescue (FTR, the probability of death after a complication) has been used to evaluate trauma care. We sought to determine whether the weekend effect impacts FTR across a mature statewide trauma system. Methods: We examined all 30 Level I and II trauma centers using the Pennsylvania Trauma Outcomes Study (PTOS) from 2007-2015. Patients age >16y with a minimum Abbreviated Injury Score 2 were included; burn patients and transfers were excluded. Our primary exposure was first major complication timing (weekday vs weekend), FTR was the primary outcome. We used multivariable logistic regression to examine the association between weekend complication occurrence and mortality. Results: Of 178,602 patients, 15,304 had a major complication [median age 58 (IQR 37-77) years, 68% male, 89% blunt injury mechanism, median injury severity score (ISS) 19 (IQR 10-29)]. Patient characteristics by complication timing were clinically similar (Table). Major complications were more likely on weekdays than weekends (9.3% vs 7.1%, p<0.001). Pulmonary and cardiac complications were most common in both groups (Table). Death occurred in 2,495 of 15,304 patients with complications, for an overall FTR rate of 16.3%. Weekday vs weekend FTR was similar (16.1% vs 16.8%; p=0.33). After controlling for patient age, ISS, complication type, and revised trauma score (RTS), there was no association between weekend complication occurrence and mortality (adjusted OR 1.03, 95% CI 0.92-1.16). Conclusions: The ability for trauma centers to rescue patients from death after a complication is not impacted by weekday or weekend complication timing. Requirements for trauma centers to be operational with full staffing at all times likely counteracts the weekend effect phenomenon seen in other time-sensitive conditions. Restructuring staffing for management of other conditions to mimic the 24/7 trauma care model may improve outcomes. Poster # 2 EVALUATION OF HELICOPTOR TRANSPORT OF TRUAMA PATIENTS IN A RURAL STATE: HAVE WE GONE TOO FAR? Lauren M. Dudas MD, Amy Tefft MD, Steven Talbert Ph.D., Daniel Davenport Ph.D., Marlene J. Broady Andrew C. Bernard* MD, University of Kentucky Introduction: Helicopter emergency medical services (HEMS) overtriage increases the cost of trauma care. Private HEMS expansion could increase overtriage. We sought to determine whether increased utilization of HEMS in our rural state is associated with overtriage. Methods: A retrospective analysis of all trauma patients transported to an ACS verified Level I trauma center via helicopter over a 26 year period (1990-2016) was performed using data from the trauma registry. HEMS overtriage was defined as one or more of the following: LOS <2 days, disposition from the ED other than ICU or OR, ISS <9. Results: 21,177 HEMS patients were transported to our center. Annual helicopter transports increased dramatically from 1990 (11) to 2016 (1076). Overall overtriage rate was 57.3%. Overtriage doubled from 2007 to 2009, which corresponds to an increase in air ambulances in the state within the same time period from 8 to 23. The counties with the highest percent of patients transported who met overtriage criteria had the furthest distance to the trauma center. Scene HEMS transports had greater overtriage rates than interfacility transfers. Patients with LEG AIS scores <2 were more likely to be transferred from the scene, 18.8% versus 11.9% (p<0.001) compared to interfacility transfers which had higher rate of facial AIS scores <2, 6.9% versus 4.4% from scene (p <0.001). Conclusion: There was a near doubling of overtriaged HEMS patients in our rural state from 2007-2009, at which time there was also a tripling of air ambulances. This suggests an increase in HEMS is likely secondary to an increased number of available helicopters and not an increase in injury severity. Our data also demonstrate that a higher percentage of patients who met overtriage criteria were transferred from the scene. However, patterns of injury were different when comparing scene versus interfacility transports. Poster # 3 DOES THE TIME OF THE DAY OF SURGERY INFLUENCE PERIOPERATIVE COMPLICATIONS – A NATIONWIDE DATABASE ANALYSIS IN 31’692 PATIENTS Sascha Halvachizadeh MD, Hans-Christoph Pape* MD, FACS, Valentin Neuhaus MD, PD University Hospital Zurich Introduction:Emergency and surgery for acute injuries is often required to avoid excessive bleeding and prevent from infections in open fractures. However, it has previously been discussed, that surgeon related factors (e.g. experience of the surgeon, teaching vs. non-teaching hospital) might play a role in adverse outcomes for these surgeries. The purpose of this study was to evaluate whether the time of day for emergent surgery is associated with complications. Methods: A prospective database (AQC, nationwide Swiss quality assurance project) was used to evaluate all trauma surgeries within 11 years in more than 70 Swiss surgical units. Inclusion criteria: All trauma coded diagnosis that were surgically treated in Swiss hospitals. Exclusion criteria: missing data for time of surgery. The daytime of surgery was stratified into morning (7AM - noon), afternoon (1PM – 6PM), evening (7PM – 11PM) and night (Midnight – 6AM). The primary outcomes were intraoperative (e.g., nerve, tendon, or vascular damage, iatrogenic fractures), postoperative (e.g., bleeding, infection, impaired wound healing, incorrect axial, rotational or length reduction) and general complications (pulmonary, cardiovascular, gastrointestinal, renal, or neurological) and mortality. Co-factors included age, gender, ASA classification, type of surgery, experience of the surgeon, length of surgery and length of stay). Variables were sought in bivariable and multivariate anylysis. Results: Of 31’692 patients, 44% were operated in the morning, 40% in the afternoon, 14% in the evening and 1.7% at night. The in-hospital mortality rate was significantly higher after nightly (2.4%) as well as afternoon surgery (1.7%). The time of surgery had no significant influence on intra- (0.5%) or postoperative complication rates (3.4%) in multivariable analysis, but a significant influence on general complications (7.9%). Afternoon- and night-surgery were significant predictors for general complications. Age, gender, higher ASA classification, and emergency procedures were typical risk factors for mortality and complications in this cohort. Conclusion: Emergency procedures performed at night and in the afternoon appears to be associated with an increased incidence of adverse outcomes. Further studies should evaluate whether this is relevant for certain diagnoses and/or procedures. Poster # 4 THE PROGNOSTIC VALUE OF NATIONAL FIELD TRAUMA TRIAGE GUIDELINES IN INJURED OLDER ADULTS AND DEVELOPMENT OF THE GERIATRIC FIELD TRAUMA TRIAGE (GFTT) SCORE Tabitha Garwe MPH,Ph.D., Kenneth Stewart MPH,Ph.D., Julie A. Stoner Ph.D., Craig D. Newgard MD,MPH, John C. Sacra MD, Patrick Cody DO,MPH, Babawale O. Oluborode MPH, MBBS, Jason S. Lees* MD, Roxie M. Albrecht* MD, University of Oklahoma Health Science Center Introduction: The Field Triage Decision Scheme developed by the American College of Surgeons Committee on Trauma (ASCOT) with periodic revision forms the basis of field triage guidelines for injured adult patients in many regions including Oklahoma. The decision scheme has been shown to have low sensitivity for seriously injured older patients. Proposed alternative criteria for injured older adults has been shown to improve sensitivity at the expense of specificity (over-triage). We sought to develop two prognostic tools with improved sensitivity and specificity to identify seriously injured older adults including those at a high risk of in-hospital mortality in the prehospital or in a resource-limited setting based on, current national field triage guidelines, previously proposed alternative criteria, and other potential risk factors such as pre-existing comorbidity. Methods: This was a retrospective cohort study of injured adults >=55 years transported directly from the scene of injury by EMS to a trauma facility for definitive care and reported to the Oklahoma State Trauma Registry between 2005 and 2014. Patient demographics, pre-existing comorbidity, variables used to define the current national field trauma triage guidelines as well as variables proposed by other investigators for alternative triage criteria were considered. The primary outcome of interest was serious injury, defined as an Injury Severity Score (ISS) >=16. In-hospital mortality was considered as a secondary outcome. Based on the two prognostic models, we developed the Geriatric Field Trauma Triage (GFTT) score to summarize identified significant risk markers/factors for the outcomes of interest. Logistic regression was used for multivariable modeling, and bootstrapping with resampling was used to adjust the prognostic models for overfitting and regression-to-the-mean bias. Results: A total of 13275 patients met study eligibility. Of these, 28.5% (3782) had an ISS >=16 (serious injury) and 9.8% (1300) died. The
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