The epidemiology of emergency department thoracotomy in a statewide trauma system: Does center volume matter?

Dumas, Ryan P.; Seamon, Mark J.; Smith, Brian P.; Yang, Wei; Cannon, Jeremy W.; Schwab, C. William; Reilly, Patrick; Holena, Daniel N.

doi:10.1097/ta.0000000000001937

Cited by 16 publications

(18 citation statements)

References 40 publications

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“…Dumas et al found evidence for other surgical disciplines and procedures. For example, they found advantageous outcomes of tracheotomies as small, routine, emergency procedures at HVCs [ 51 ]. Amato et al found advantages for HVCs for 26 clinical areas, including hip fractures [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Vehling

Canal

Ziegenhain

et al. 2021

Eur J Trauma Emerg Surg

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Introduction In light of current discussions about centralisation and teaching in medicine, we wanted to investigate the differences in in-hospital outcomes after surgical treatment of isolated ankle fractures, taking into account high-volume centres (HVCs) and low-volume centres (LVCs) and teaching procedures. Methods A retrospective analysis of malleolar fractures recorded in a National Quality Assurance Database (AQC) from the period 01-01-1998 to 31-12-2018 was carried out. Inclusion criteria were isolated, and operatively treated lateral malleolar fractures (ICD-10 Code S82.6 and corresponding procedure codes). Variables were sought in bivariate and multivariate analyses. A total of 6760 cases were included. By dividing the total cases arbitrarily in half, 12 HVCs (n = 3327, 49%) and 56 LVCs (n = 3433, 51%) were identified. Results Patients in HVCs were younger (48 vs. 50 years old), had more comorbidities (26% vs. 19%) and had more open fractures (0.48% vs. 0.15%). Open reduction and internal fixation was the most common operative treatment at HVCs and LVCs (95% vs. 98%). A more frequent use of external fixation (2.5% vs. 0.55%) was reported at HVCs. There was no difference in mortality between treatment at HVCs and LVCs. A longer hospitalisation of 7.2 ± 5 days at HVCs vs. 6.3 ± 4.8 days at LVCs was observed. In addition, a higher rate of complications of 3.2% was found at HVCs compared to 1.9% at LVCs. The frequency of teaching operations was significantly higher at HVCs (30% vs. 26%). Teaching status had no influence on mortality or complications but was associated with a prolonged length of stay and operating time. Conclusion We found significant differences between HVCs and LVCs in terms of in-hospital outcomes for ankle fractures. These differences could be explained due to a more severely ill patient population and more complex (also open) fracture patterns with resulting use of external fixation and longer duration of surgery. However, structural and organisational differences, such as an extended preoperative stays at HVCs and a higher teaching rate, were also apparent. No difference in mortality could be detected.

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Section: Discussionmentioning

confidence: 99%

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Vehling

Canal

Ziegenhain

et al. 2021

Eur J Trauma Emerg Surg

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“…[ 16 17 18 19 ] A recent study in a single state by Dumas et al . [ 7 ] found that patients presenting to centers that had a higher mean annual volume of EDTs performed had significantly higher odds of survival. Unfortunately, we are restricted by the HCUP policies on reporting data with <10 observations and are unable to report the survival among this population.…”

Section: Discussionmentioning

confidence: 99%

“…Although urban institutions overall perform a higher volume of EDTs, evidence has not shown that teaching status has a significant effect on patient outcomes from EDT. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

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A national study of emergency thoracotomy for trauma

Hansen

Hosokawa

McIntyre

et al. 2021

J Emerg Trauma Shock

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Introduction: The role of resuscitative thoracotomy in the emergency department (ED) for patients that have suffered severe thoracoabdominal trauma has been the subject of much debate. Most studies that characterize emergency thoracotomy are from urban, academic, and trauma centers. We sought to describe patient and hospital characteristics of a nationally representative sample of ED thoracotomy (EDT). Methods: The health-care cost and utilization project 2013 National ED Sample (NEDS) and the 2013 National Inpatient Sample (NIS) maintained by the agency for health-care research and quality were used to generate a nationally representative estimate of resuscitative thoracotomies performed in the ED. We obtained patient demographics and clinical characteristics and compared the descriptive statistics of the two datasets. Results: The NEDS dataset identified 124 unsuccessful EDTs, whereas the NIS dataset identified 77 admissions for thoracotomy. When weighted to create a national estimate, these represent 952 emergency thoracotomies performed in the US in 2013. Most were male (82.5% and 88.2% in NEDS and NIS, respectively). In addition, 32.9% and 36.4% in NEDS and NIS, respectively, were between the ages of 20 and 29. The majority of thoracotomies were performed at metropolitan teaching hospitals (64.2% and 75.3%, NEDS and NIS, respectively). The mean total ED charges for patients who had an unsuccessful thoracotomy were $32,664 and the mean total inpatient charges were $141,215. Conclusion: Nearly 1000 thoracotomies are performed annually on the day of presentation to U. S. hospitals. Although emergency thoracotomy for trauma is an infrequently performed procedure, it almost always occurs at an urban, high volume, and level I or level II trauma centers.

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“…First responders usually lack the clinical experience necessary for treating complex patients, let alone in stressful situations 1. When lifesaving interventions are due, level of experience is yet another key factor impacting procedure success rate 2–4…”

Section: Introductionmentioning

confidence: 99%

Augmenting prehospital care

et al. 2020

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IntroductionThe challenging environment of prehospital casualty care demands providers to make prompt decisions and to engage in lifesaving interventions, occasionally without them being adequately experienced. Telementoring based on augmented reality (AR) devices has the potential to decrease the decision time and minimise the distance gap between an experienced consultant and the first responder. The purpose of this study was to determine whether telementoring with AR glasses would affect chest thoracotomy performance and self-confidence of inexperienced trainees.MethodsTwo groups of inexperienced medical students performed a chest thoracotomy in an ex vivo pig model. While one group was mentored remotely using HoloLens AR glasses, the second performed the procedure independently. An observer assessed the trainees’ performance. In addition, trainees and mentors evaluated their own performance.ResultsQuality of performance was found to be superior with remote guidance, without significant prolongation of the procedure (492 s vs 496 s, p=0.943). Moreover, sense of self-confidence among participant was substantially improved in the telementoring group in which 100% of the participants believed the procedure was successful compared with 40% in the control group (p=0.035).ConclusionAR devices may have a role in future prehospital telementoring systems, to provide accessible consultation for first responders, and could thus positively affect the provider's confidence in decision-making, enhance procedure performance and ultimately improve patient prognosis. That being said, future studies are required to estimate full potential of this technology and additional adjustments are necessary for maximal optimisation and implementation in the field of prehospital care.

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The epidemiology of emergency department thoracotomy in a statewide trauma system: Does center volume matter?

Abstract: Prognostic/Epidemiological, level III; Therapeutic, level IV.

Cited by 16 publications

References 40 publications

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study

A national study of emergency thoracotomy for trauma

Augmenting prehospital care

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