Trauma patients are at high risk for loss to follow-up (LTFU) after hospital discharge. We sought to identify risk factors for LTFU and investigate associations between LTFU and long-term health ...outcomes in the trauma population.
Trauma patients with an Injury Severity Score ≥9 admitted to one of three Level-I trauma centers, 2015-2020, were surveyed via telephone 6 mo after injury. Univariate and multivariate analyses were performed to assess factors associated with LTFU and several long-term outcomes.
Of 3609 patients analyzed, 808 (22.4%) were LTFU. Patients LTFU were more likely to be male (71% versus 61%, P = 0.001), Black (22% versus 14%, P = 0.003), have high school or lower education (50% versus 42%, P = 0.003), be publicly insured (23% versus 13%, P < 0.001), have a penetrating injury (13% versus 8%, P = 0.006), have a shorter length of stay (3.64 d ± 4.09 versus 5.06 ± 5.99, P < 0.001), and be discharged home without assistance (79% versus 50%, P < 0.001). In multivariate analyses, patients who followed up were more likely to require assistance at home (6% versus 11%; odds ratio OR 2.23, 1.26-3.92, P = 0.005), have new functional limitations (11% versus 26%; OR 2.91, 1.97-4.31, P = < 0.001), have daily pain (30% versus 48%; OR 2.11, 1.54-2.88, P = < 0.001), and have more injury-related emergency department visits (7% versus 10%; OR 1.93, 1.15-3.22, P = 0.012).
Vulnerable populations are more likely to be LTFU after injury. Clinicians should be aware of potential racial and socioeconomic disparities in follow-up care after traumatic injury. Future studies investigating improvement strategies in follow-up care should be considered.
Objective
To evaluate the impact of a post‐Helping Babies Breathe bundle of interventions on the retention of provider‐level knowledge and skills.
Method
The present prospective pre–post study ...following a 1‐day Helping Babies Breathe training of professional midwives, physicians, and nurses was conducted in Cajamarca Province, Peru between January 1 and July 31, 2017. The interventions to improve retention included structured worksite practice before every shift, weekly in‐service simulated scenarios, and monthly supervised peer‐to‐peer abbreviated refresher trainings. Knowledge and skills were assessed before, immediately after, and 6 months after training using two validated multiple‐choice knowledge test and objective structured clinical examinations (OSCEs; OSCE A and OSCE B). Data were analyzed for changes in knowledge and skills over time and to identify predictors of performance.
Results
There were 60 learners included. No significant differences were observed between assessments immediately after training and at 6‐month follow‐up for knowledge scores or time‐to‐effective‐ventilation. Pass rates for OSCE B increased from 83% immediately after training to 95% at follow‐up (P=0.007). The only factor associated with a reduced time to effective ventilation at 6‐month follow‐up was working in a hospital (P<0.001), accounting for years of training and experience.
Conclusion
Helping Babies Breathe knowledge and skills can be retained and even improved with simple, inexpensive interventions, including supervised on‐the‐job and peer‐to‐peer training.
A bundle of low‐cost interventions improved retention of knowledge and skills following Helping Babies Breathe training in a resource‐limited setting.
Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and ...can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients.
Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index TPI), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic.
Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p < 0.05). Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval CI, 1.6-3.7) and mortality at 30 days (hazard ratio HR, 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9).
Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is a simple and objective measure of frailty that identifies vulnerable patients for improved preoperative counseling, setting realistic goals of care, and consideration of less invasive approaches.
Prognostic study, level III.
Background
Suitability is a patient-centered metric defined as how appropriately health information is targeted to specific populations to increase knowledge. However, suitability is most commonly ...evaluated exclusively by healthcare professionals without collaboration from intended audiences. Suitability (as rated by intended audiences), accuracy and readability have not been evaluated on websites discussing pancreatic cancer.
Methods
Ten healthy volunteers evaluated fifty pancreatic cancer websites using the suitability assessment of materials (SAM instrument) for the materials’ overall suitability. Readability and accuracy were correlated.
Results
Ten recruited volunteers (ages 23–63, 50% female) found websites to be on average “adequate” or “superior” in suitability. Surgery, radiotherapy and nonprofit websites had higher suitability scores as compared to counterparts (
p
≤ 0.03). There was no correlation between readability and accuracy levels and suitability scores (
p
≥ 0.3). Presence of visual aids was associated with better suitability scores after controlling for website quality (
p
≤ 0.01).
Conclusion
Suitability of websites discussing pancreatic cancer treatments as rated by lay audiences differed based on therapy type and website affiliation, and was independent of readability level and accuracy of information. Nonprofit affiliation websites focusing on surgery or radiotherapy were most suitable. Online information should be assessed for suitability by target populations, in addition to readability level and accuracy, to ensure information reaches the intended audience.
To provide an overview of the practical skills learning curriculum and assess its effects over time on the surgical interns’ perceptions of their technical skills, patient management, administrative ...tasks, and knowledge.
An 84-hour practical skills curriculum composed of didactic, simulation, and practical sessions was implemented during the 2015 to 2016 academic year for general surgery interns. Totally, 40% of the sessions were held during orientation, whereas the remainder sessions were held throughout the academic year. Interns’ perceptions of their technical skills, administrative tasks, patient management, and knowledge were assessed by the practical skills curriculum residents’ perception survey at various time points during their intern year (baseline, midpoint, and final). Interns were also asked to fill out an evaluation survey at the completion of each session to obtain feedback on the curriculum.
General Surgery Residency program at a tertiary care academic institution.
20 General Surgery categorical and preliminary interns.
Significant differences were found over time in interns’ perceptions on their technical skills, patient management, administrative tasks, and knowledge (p < 0.001 for all). The results were also statistically significant when accounting for a prior boot camp course in medical school, intern status (categorical or preliminary), and gender (p < 0.05 for all). Differences in interns’ perceptions occurred both from baseline to midpoint, and from midpoint to final time point evaluations (p < 0.001 for all). Prior surgical boot camp in medical school status, intern status (categorical vs. preliminary), and gender did not differ in the interns’ baseline perceptions of their technical skills, patient management, administrative tasks, and knowledge (p > 0.05 for all).
Implementation of a Practical Skills Curriculum in surgical internships can improve interns’ confidence perception on their technical skills, patient management skills, administrative tasks, and knowledge.
Firearm injuries’ association with individual-level socioeconomic risk is well described. Trauma research has suggested that neighborhood level risk factors may be associated with differences in ...firearm injury outcome. We analyzed the relationship between hospital length of stay (LOS), mortality and neighborhood level social markers from the Center for Disease Control (CDC) Social Vulnerability Index (SVI) after firearm injury.
We used the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) in 2016 to identify firearm injuries using ICD-10 E-codes. Patient locations were identified at the census tract level. The 2016 CDC SVI was used to evaluate neighborhood level social vulnerability. Logistic and linear multivariable regression were used to evaluate the association between SVI percentile rank, mortality, and LOS.
We identified 9,764 cases of firearm injury in our database; 88.2% of individuals were male, and the average age was 33.8 years. Assault was the most common intent, accounting for 4682 (48.0%) of all admissions. Overall, SVI was correlated with the risk of firearm injury, but not associated with either outcome of length of stay or risk of death.
While there is significant disparity between SVI and risk of firearm injury, once admitted to the hospital outcomes are similar between low and high-vulnerable populations. To reduce disparities in risk, funding and effort should focus on primary prevention.
A significant proportion of patients who survive traumatic injury continue to suffer impaired functional status and increased mortality long after discharge. However, despite the need to improve ...long-term outcomes, trauma registries in the USA do not collect data on outcomes or care processes after discharge. One of the main barriers is the lack of consensus regarding the optimal outcome metrics.
To describe the methodology of a scoping review evaluating current evidence on the available measures for tracking functional and patient-reported outcomes after injury. The aim of the review was to identify and summarize measures that are being used to track long-term functional recovery and patient-reported outcomes among adults after injury.
A systematic search of PubMed and Embase will be performed using the search terms for the population (adult trauma patients), type of outcomes (long-term physical, mental, cognitive, and quality of life), and measures available to track them. Studies identified will be reviewed and assessed for relevance by at least two reviewers. Data will be extracted and summarized using descriptive statistics and a narrative synthesis of the results. This protocol is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
This scoping review will provide information regarding the currently available metrics for tracking functional and patient-reported outcomes after injury. The review will be presented to a multi-disciplinary stakeholder group that will evaluate these outcome metrics using an online Delphi approach to achieve consensus as part of the development of the National Trauma Research Action Plan (NTRAP). The results of this review will be presented at relevant national surgical conferences and published in peer-reviewed scientific journals.
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