Relationship between trauma center patient volume (TCV) and mortality remains inconclusive. Our aim was to determine the relationship between TCVs and observed/expected (O/E) all-cause mortality. This is the first study to evaluate the relationship between trauma center (TC) volumes and O/E all-cause mortality with no exclusion. Review of prospectively collected data from 94 TCs using the National Sample Program from the National Trauma Data Bank 2013. TCs were stratified into five groups based on TCV: <701, 701 to 1200, 1201 to 1700, 1701 to 2200, and >2200 yearly patient encounters. Chi-square and coefficient of determination were used for data analysis with a statistical significance defined as P-value < 0.05. A total of 139,324 trauma patients with blunt and penetrating injuries were evaluated from the National Sample Program. Of which, 63.6 per cent were male, 70.6 per cent white, and the average age was 41 years. The data were stratified by TCV into five groups with average O/Es ranging from 0.69 to 0.86 (P > 0.05). The coefficient of determination between TCV and O/E was r = 0.14 and r2 = 0.02. When controlling for Injury Severity Score, the correlation between mechanism of injury (blunt vs penetrating) and O/E mortality was r = 20.025. The group with the lowest average volumes had statistically significantly worse outcomes than the group with next higher volumes and also worse than the group with the highest volumes (Group 5, P = 0.04). Higher TC volumes correlated with higher injury severity and lower O/E mortality.

BackgroundEarly operative intervention for hip fractures in the elderly is advised to reduce mortality and morbidity. Postoperative complications impose a significant burden on patient outcomes and cost of medical care. Our aim was to determine the relationship between time to surgery and postoperative complications/mortality in patients with hip fracture.MethodsThis is a retrospective review of data collected from our institution’s trauma registry for patients ≥65 years old with isolated hip fracture and subsequent surgery from 2015 to 2017. Patients were stratified into two groups based on time to surgery after admission: group 1: <48 hours versus group 2: >48 hours. Demographic variables included age, gender, race, and Injury Severity Score (ISS). The outcome variables included intensive care unit length of stay (ICU-LOS), deep venous thrombosis (DVT), pulmonary embolism (PE) rate, mortality, and 30-day readmission rates. Analysis of variance was used for analysis, with significance defined as a p value <0.05.ResultsA total of 485 patients with isolated hip fracture required surgical intervention. Of those, 460 had surgery <48 hours and 25 had surgery >48 hours postadmission. The average ISS was the same in both groups. The average ICU-LOS was significantly higher in the >48 hours group compared with the <48 hours group (4.0 vs. 2.0, p<0.0002). There was no statistically significant difference between groups when comparing DVTand PE rate, 30-day readmission, or mortality rates.DiscussionTime to surgery may affect overall ICU-LOS in patients with hip fracture requiring surgical intervention. Time to surgery does not affect complication rates, 30-day readmission, or mortality. Future research should investigate long-term outcomes such as functional status and disability-adjusted life years.Level of evidenceIII. Retrospective/ prognostic cohort study

Objectives: The Centers for Disease Control and Prevention has reported increased rates of coronavirus disease 2019 (COVID-19)-related hospitalizations and deaths in Black and Hispanic individuals. One contributing factor to this may be a difference in access to treatment. We thus sought to compare the outcomes of Black, non-Hispanic patients and Hispanic patients with White, non-Hispanic individuals using a group of patients with COVID-19 who received casirivimab/imdevimab.Methods: This was a secondary analysis of data from a previously published retrospective chart review of patients who received casirivimab/ imdevimab for COVID-19 between December 9, 2020 and August 20, 2021, when they were treated at one of three facilities within a single hospital system. We compared the baseline characteristics (including age, sex, body mass index, duration of symptoms, and vaccination status) and outcomes of Black, non-Hispanic patients and Hispanic patients with those of White, non-Hispanic patients. Our primary outcome was the odds of a return visit to the emergency department (ED) within 28 days of treatment as assessed by multivariate logistic regression. We also assessed the rates of return visits to the ED for symptoms caused by COVID-19, hospitalizations, and hospitalizations from hypoxia.Results: In total, 1318 patients received casirivimab/imdevimab for COVID-19 at the three study facilities. Of these, 410 (31.1%) identified themselves as White and non-Hispanic, 88 (6.7%) as Black and non-Hispanic, and 736 (55.8%) as Hispanic. Vaccination rates at the time of treatment were as follows: Black, non-Hispanic 10.2%, Hispanic 13.6%, and White, non-Hispanic 21.5%. On multivariate analysis, the odds of return visits to the ED within 28 days were higher for Black, non-Hispanic patients and Hispanic patients as compared with White, non-Hispanic patients, with odds ratios of 2.8 (95% confidence interval [CI] 1.4-5.5, P = 0.003) and of 2.3 (95% CI 1.5-3.6, P = 0.0002), respectively. For hospitalizations caused by hypoxia within 28 days of treatment, the adjusted odds ratio for Black, non-Hispanic patients was 3.4 (95% CI 1.1-10.5, P = 0.03) as compared with White, non-Hispanic patients. There were no other statistically significant differences among groups in regard to subsequent hospitalizations within 28 days.Conclusions: Black, non-Hispanic patients and Hispanic patients are more likely to make a return visit to the ED within 28 days after casirivimab/imdevimab treatment for COVID-19 as compared with White, non-Hispanic patients. This holds true even when adjusting for higher vaccination rates among White, non-Hispanic individuals.