The prevalence of video-based assessment and review is rising, and trauma video review (TVR) has proven to be an effective means of enhancing education, improving quality, and facilitating research. Despite this, a complete understanding of the trauma team's view on TVR remains elusive.
Positive and negative team member perceptions of TVR were assessed across multiple groups. Our supposition was that the trauma team would find the training modules presented via TVR beneficial in a learning capacity, and further, anxiety levels would be uniformly low across all group memberships.
During the weekly multidisciplinary trauma performance improvement conference, a follow-up anonymous electronic survey was given to nurses, trainees, and faculty after every TVR activity. Surveys were designed to measure the perception of performance improvement and the presence of anxiety or apprehension, with a Likert scale that ranged from strongly disagree (1) to strongly agree (5). The results include individual and normalized cumulative scores; the average response for each positive (n = 6) and negative (n = 4) question stem.
Over eight months, we meticulously examined 146 surveys, achieving a remarkable 100% completion rate. The respondent group included trainees (58 percent), faculty (29 percent), and nurses (13 percent). Seventy-three percent of the trainees were in postgraduate year (PGY) levels 1, 2, or 3, and the remaining twenty-seven percent were in PGY years 4 through 9. Among the respondents, 84% had prior experience participating in a TVR conference. The respondents noted an enhanced perception of the quality of resuscitation education and the growth of their leadership abilities. Participants' overall opinion was that the educational value of TVR was more prominent than its punitive nature. Classifying team members by type highlighted lower performance scores for faculty members on all positive statements in the assessments. Trainees with lower postgraduate years (PGY) were significantly more prone to concur with negative-stemmed questions, a tendency that was least evident among nurses.
Trainees and nurses, participating in TVR's conference-based trauma resuscitation education, highlight its profound impact. Antioxidant chemical In terms of TVR, nurses demonstrated the least apprehension.
Conferences hosted by TVR are instrumental in improving trauma resuscitation education, particularly beneficial to trainees and nurses. Regarding TVR, nurses demonstrated a notable lack of apprehension.
The protocol for massive transfusions must be continuously evaluated to improve the outcomes seen in trauma patients.
This quality improvement initiative investigated the association between provider compliance to a newly revised massive transfusion protocol and its correlation with clinical outcomes among trauma patients requiring massive transfusions.
The relationship between provider adherence to a revised massive transfusion protocol and clinical results in trauma patients with hemorrhage was studied using a descriptive, correlational, retrospective design at a Level I trauma center from November 2018 through October 2020. Patient features, adherence levels to the provider's massive transfusion protocol, and the eventual results for patients were examined. Associations between patient characteristics, massive transfusion protocol adherence, and 24-hour survival and survival-to-discharge were examined using bivariate statistical techniques.
Ninety-five trauma patients, whose cases necessitated the activation of the massive transfusion protocol, underwent a comprehensive evaluation. Following the activation of the massive transfusion protocol, 71 (75%) of the 95 patients survived the initial 24 hours, and 65 (68%) ultimately survived until discharge. Analyzing protocol-applicable elements, the median adherence to the massive transfusion protocol was 75% (interquartile range 57%–86%) for the 65 survivors and 25% (interquartile range 13%–50%) for the 21 non-survivors, whose deaths occurred at least one hour post-activation of the protocol (p < .001).
The findings clearly demonstrate the significance of continuing evaluations regarding adherence to massive transfusion protocols in hospital trauma settings, thus allowing for targeted improvements.
To improve adherence to massive transfusion protocols in hospital trauma settings, ongoing evaluations, as evidenced by findings, are essential for pinpointing specific areas needing attention.
Dexmedetomidine, acting as an alpha-2 receptor agonist, is frequently employed for continuous sedation and analgesia via infusion; however, dose-dependent decreases in blood pressure could restrict its clinical use. While prevalent, a standard dosage and titration strategy remains elusive.
We sought to examine whether a dexmedetomidine dosing and titration protocol demonstrates an association with a reduced incidence of hypotension in trauma patients.
In the Southeastern United States, at a Level II trauma center, a pre-post intervention study was conducted from August 2021 to March 2022. Patients admitted by the trauma service to either the surgical trauma intensive care unit or the intermediate care unit and receiving dexmedetomidine for a minimum of six hours constituted the study population. Patients with baseline hypotension or vasopressor use were ineligible for inclusion in the study group. Hypotension incidence served as the primary outcome measure. The secondary outcomes investigated included the methods of drug dosing and titration, the initiation of a vasopressor, instances of bradycardia, and the time needed to attain the target Richmond Agitation Sedation Scale (RASS) score.
Eighty-nine individuals met the inclusion criteria and were allocated to two groups: the pre-intervention group, with thirty members; and the post-intervention group, with twenty-nine. Antioxidant chemical Within the post-group, protocol adherence amounted to 34%, with a median of one violation per patient. The groups exhibited similar proportions of hypotension (60% versus 45%, p = .243), indicating no significant difference. Post-protocol patients with no violations exhibited a substantially reduced rate compared to the pre-protocol group (60% vs. 20%, p = .029). The post-group's maximal dose was statistically significantly lower (p < .001) at 11 g/kg/hr, compared to the 07 g/kg/hr dose received by the control group. A lack of notable differences was found in the initiation of vasopressor therapy, the presence of bradycardia, or the time required to achieve the desired RASS value.
Protocol adherence to dexmedetomidine dosing and titration significantly lowered the incidence of hypotension and maximal dose of dexmedetomidine, without extending the time needed to achieve the target RASS score, in critically ill trauma patients.
In critically ill trauma patients, strict adherence to a dexmedetomidine dosing and titration protocol led to a substantial decrease in the incidence of hypotension and maximal dexmedetomidine dose, while maintaining the time required to attain the target RASS score.
Utilizing the PECARN traumatic brain injury algorithm in pediatric emergency care, clinicians can distinguish children at low risk of clinically significant traumatic brain injuries, thus reducing CT scans. Enhancing diagnostic accuracy through PECARN rule modification, tailored to population-specific risk profiles, has been proposed.
This study aimed to pinpoint patient-specific characteristics, distinct from PECARN guidelines, which could improve the recognition of individuals needing neurological imaging.
In a Southwestern U.S. Level II pediatric trauma center, a single-center, retrospective cohort study took place from July 1, 2016, to July 1, 2020. Adolescents, falling within the age range of 10 to 15, with a Glasgow Coma Scale assessment of 13 to 15, who had sustained a confirmed mechanical blow to the head, were considered for inclusion. Patients not possessing head CT data were eliminated from the investigation. Logistic regression served as the method of choice to discover additional complicated mild traumatic brain injury predictive variables surpassing those of the PECARN criteria.
The 136 patients studied included 21 (15%) who were identified with a complicated mild traumatic brain injury. A striking difference in odds emerged between motorcycle collisions and all-terrain vehicle injuries (odds ratio [OR] 21175, 95% confidence interval, CI [451, 993141], p < .001). Antioxidant chemical The observed unspecified mechanism (420, 95% confidence interval [130, 135097], p = .03) is noteworthy. Activation was studied, and a noteworthy association was detected (OR 1744, 95% CI [175, 17331], p = .01). There were noteworthy links between complicated mild traumatic brain injuries and these factors.
Motorcycle crashes and all-terrain vehicle injuries, along with undetermined mechanisms and consultation requests, constituted additional factors impacting complex mild traumatic brain injuries, not considered in the PECARN imaging decision rule. Considering these variables may provide insight into the requirement for a CT scan.
We noted further contributing elements to complex mild traumatic brain injury, including motorcycle collisions, all-terrain vehicle injuries, unspecified mechanisms, and consultation requests, which were not part of the PECARN imaging decision protocol. These variables could potentially influence the judgment as to whether CT scanning is necessary.
The growing presence of geriatric trauma patients, significantly vulnerable to adverse outcomes, is straining trauma centers' resources. Trauma centers support geriatric screening, yet struggle to establish a consistent methodology.
This study seeks to delineate the influence of the Identification of Seniors at Risk (ISAR) screening process on patient outcomes and geriatric assessments.
This study, employing a pre-post design, examined the effects of ISAR screening on trauma patient outcomes and geriatric evaluations for those aged 60 or older, comparing data from the time before (2014-2016) and after (2017-2019) the screening program's introduction.
A review of charts was conducted for 1142 patients.