Although the prevailing stereotype is that most hunting injuries are gunshot wounds inflicted by intoxicated hunting buddies, our experience led us to hypothesize that falls comprise a significant proportion of hunting related injuries. Trauma databases of two Level I trauma centers in central Ohio were queried for all hunting related injuries during a 10-year period. One hundred and thirty patients were identified (90% male, mean age 41.0 years, range 17-76). Fifty per cent of injuries resulted from falls, whereas gunshot wounds accounted for 29 per cent. Most hunters were hunting deer and 92 per cent of falls were from tree stands. Alcohol was involved in only 2.3 per cent, and drugs of abuse in 4.6 per cent. Of gunshots, 58 per cent were self-inflicted, and 42 per cent were shot by another hunter. Tree stand falls were highly morbid, with 59 per cent of fall victims suffering spinal fractures, 47 per cent lower extremity fractures, 18 per cent upper extremity fractures, and 18 per cent closed head injuries. Surgery was required for 81 per cent of fall-related injuries, and 8.2 per cent of fall victims had permanent neurological deficits. In contrast to prevailing beliefs, in our geographic area tree-stand falls are the most common mechanism of hunting related injury requiring admission to a Level 1 trauma center.

BackgroundTraumatic abdominal wall hernias (TAWHs) are a rare clinical entity that can be difficult to diagnose and manage. There is no consensus on management of TAWH due to its low incidence and complex concomitant injury patterns. We hereby present the largest single-center case series in the USA to characterize associated injury patterns, identify optimal strategies for hernia management, and determine outcomes.MethodsPatients who presented with a TAWH from blunt trauma requiring operative management were retrospectively identified over a 14-year period. Demographic data, Injury Severity Score (ISS), associated injuries, type of repair, durability of repair, and complications were collected, and descriptive statistics were calculated.ResultsFifteen patients were identified. The average age was 31±11 years, ISS 15±9, and body mass index 33.4±7.1 kg/m2. Mechanisms included falls (13%), motor vehicle collisions (60%), motorcycle accidents (20%), and pedestrian versus motor vehicle collisions (7%). The most commonly associated injuries included colonic injuries (53%), long bone fractures (47%), pelvic fractures (40%), and small bowel injuries (33%). Nineteen hernia repairs were performed: 6 underwent primary suture repair (32%) and 13 used mesh (68%). There were four recurrences. We could not find any significant relationship between contamination and mesh use or recurrence. There was one mortality related to sepsis.DiscussionTAWHs have an associated injury pattern involving fractures and abdominopelvic visceral injuries where a tailored approach is advisable. Without hollow viscous injuries and gross contamination, these hernias can be repaired safely with mesh in the acute setting. However, in patients with gross contamination or hemodynamic instability, the risk of recurrence with primary repair must be weighed against the risk of infection and prolonged surgery with mesh repair. In those cases, a delayed reconstruction in the elective setting may be optimal.

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Background A novel, recently FDA-authorized software uses deep learning (DL) to provide prescriptive transthoracic echocardiography (TTE) guidance, allowing novices to acquire standard TTE views. The DL model was trained by >5,000,000 observations of the impact of probe motion on image orientation/quality. This study evaluated whether novice-acquired TTE images guided by this software were of diagnostic quality in patients with and without implanted electrophysiological (EP) devices, focusing on RV size and function, which were thought to be sensitive to EP devices. Some aspects of the study have previously been presented. Methods 240 patients (61±16 years old, 58% male, 33% BMI >30 kg/m2, 91% with cardiac pathology) were recruited. 8 nurses without echo experience each acquired 10 view TTEs in 30 patients guided by the software. 235 of the patients were also scanned by a trained sonographer without assistance from the software. 5 Level 3 echocardiographers independently assessed the diagnostic quality of the TTEs acquired by the nurses and sonographers to evaluate the effect of EP devices on DL software performance. Results Nurses using the AI-guided acquisition software acquired TTEs of sufficient quality to make qualitative assessments of right ventricular (RV) size and function in greater than 80% of cases for patients with and without implanted EP devices (Table). There was no significant difference between nurse- and sonographer-acquired scans. Conclusion These results indicate that new DL software can guide novices to obtain TTEs that enable qualitative assessment of RV size even in the presence of implanted EP devices. The results of the comparison to sonographer-acquired exams indicate the software performance is robust to presence of pacemaker/ICD leads visible in the images (Figure). Nurse-acquired TTE with visible ICD lead Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Caption Health, Inc.

Objective To analyze the trends in demographics and outcomes of patients presenting with traumatic brain injury by performing a retrospective database review of the Illinois Department of Public Health (IDPH) Trauma Registry. Methods We utilized the IDPH Trauma Registry to retrieve data on patients treated for traumatic brain injuries at our large, tertiary care hospital from 2004 to 2012, inclusive. From this data, logistic regression models were used to analyze and compare basic demographics such as age, sex, and clinical outcome. Results Three thousand and thirty-nine patients were analyzed with a mean age of 43 (standard deviation, 24) and a median age of 41 (interquartile range, 23 to 60). Over the study period, patients’ age increased steadily from 32 to 49 years. The percentage of female patients increased, from 16.4% to 27.5% over the last 4 years. Overall mortality was greater for males than females (22.1% vs. 17.3%; odds ratio [OR], 1.36; 95% confidence interval [CI], 1.10 to 1.68). Mortality decreased over the period (OR, 0.88; 95% CI, 0.85 to 0.91), with a greater decrease in females (OR, 0.84; 95% CI, 0.78 to 0.90) than in males (OR, 0.90; 95% CI, 0.86 to 0.94). Conclusion Although the age of patients presenting with traumatic brain injury is increasing substantially, the data suggests that overall mortality appears to be decreasing, and this decrease appears to be greater in females than in males. These changes in trends found in the IDPH Trauma Registry supports the importance for further analysis of other reliable public datasets to identify areas of future study.

This study represents the first attempt at evaluating the ability of the CureViolence Hospital-Response Intervention Program (previously CeaseFire) to disrupt the pattern of violent reinjury. The clinical data points of 300 African American men who presented to our trauma center with a gunshot wound and received intervention at the bedside between 2005 and 2007 (with a 48-month follow-up) were collected. This cohort was matched with a post hoc historical control group using hospital records from 2003 to 2005. The mean age for both groups was 23.9 years. Odds ratios and 95% confidence intervals were obtained. Using a binary logistical regression model, we assessed the performance of three variables of interest: age at the time of the initial injury, treatment group, and initial disposition group to predict recidivism. We utilized the Nagelkerke R square method, which described the proportion of the variance of the reinjury rate and validated our findings using the Hosmer–Lemeshow test (for goodness-of-fit). Six percent ( n = 18) of subjects in the treatment group and 11% ( n = 33) in the control group returned with a new injury, yielding a total reinjury rate of 8.5%. Most patients returned only once with another violent injury. Individuals who did not receive CureViolence services were nearly twice as likely (odds ratio = 1.94; 95% confidence interval = 1.065, 3.522) to return with a violent reinjury. This finding suggests that Hospital-Response Intervention Programs (HRIP) have a protective effect in violently injured patients. We therefore conclude our HRIP positively affected at-risk patients and prevented violent reinjury.

Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify missed billing opportunities can help create solutions to recover these revenues.

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