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Trauma registries have been designed to serve a number of purposes, including quality improvement, injury prevention, clinical research, and policy development. Since their inception over 30 years ago, there are increasingly more institutions with trauma registries, many of which submit data to a national trauma registry. The goal of this review is to describe the history, logistics, and characteristics of trauma registries and their contribution to emergency medicine and trauma research. Discussed in this review are the limitations of trauma registries, such as variability in quality and type of the collected data, absence of data pertaining to long-term and functional outcomes, prehospital information, and complications as well as other methodologic obstacles limiting the utility of registry data in clinical and epidemiologic research.

Existing evidence indicates that POCUS is useful in identifying abscess in ED patients with SSTI. In cases where physical examination is equivocal, POCUS can assist physicians to distinguish abscess from cellulitis.

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Emergency Departments (EDs) face significant challenges in providing efficient, quality, safe, cost-effective care. Lean methodologies are a proposed framework to redesign ED practices and processes to meet these challenges. We outline a systematic way that lean principles can be applied across the entire ED patient experience to transform a high volume ED in a safety net hospital. We review the change in ED performance metrics prior to and after lean implementation. We discuss critical insights and key lessons learned from our lean transformation to date. The steps to implementing lean principles across the patient's ED experience are described with specific attention to executive planning of rapid improvement experiments and the subsequent roll-out of lean transformation over an 18-month time frame. Basic ED performance data were compared to the year prior. Results of the exploratory analysis (using median and interquartile ranges and nonparametric tests for group comparisons) have shown improvement in several performance metrics after initiating lean transformation. The approach, lessons learned, and early data of our transformation can provide critical insights for EDs seeking to incorporate continuous improvement strategies. Key lessons and unique challenges encountered in safety net hospitals are discussed.

OBJECTIVE The antifibrinolytic agent tranexamic acid (TXA) has demonstrated clinical benefit in trauma patients with severe bleeding but its effectiveness in patients with traumatic brain injury (TBI) is unclear. We conducted a systematic review to evaluate the following research question: In ED patients with or at risk of intracranial hemorrhage secondary to TBI, does TXA compared to placebo improve patients’ outcomes? METHODS MEDLINE, EMBASE, CINAHL and other databases were searched for randomized (RCT) or quasi-RCT studies that compared the effect of TXA to placebo on outcomes of TBI patients. The main outcomes of interest included mortality, neurological function, hematoma expansion, and adverse effects. We used “Grading quality of evidence and strength of recommendations” (GRADE) to assess the quality of trials. Two authors independently abstracted data using a data collection form. Results from studies were pooled when appropriate. RESULTS Out of 1030 references identified through the search, two high-quality RCTs met inclusion criteria. The effect of TXA on mortality had a pooled relative risk (RR) of 0.64 (95%CI, 0.41–1.02), on unfavorable functional status a RR of 0.77 (95%CI, 0.59–1.02), and on intracranial hemorrhage progression a RR of 0.76 (95%CI, 0.58–0.98). No serious adverse effects (such as thromboembolic events) associated with TXA group were reported in the included trials. CONCLUSION Pooled results from the two RCTs demonstrated statistically significant reduction in intracranial hemorrhage progression with TXA and a non-statistically significant improvement of clinical outcomes in ED patients with TBI. Further evidence is required to support its routine use in patients with TBI.

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