No abstract

» A multidisciplinary approach to the management of pelvic ring injuries has been shown to decrease mortality rates.» The primary goals within the emergency room are to assess, resuscitate, and stabilize the patient. The Advanced Trauma Life Support protocol guides the initial assessment of the patient. A pelvic binder or sheet should be applied to help to provide reduction of the fracture and temporary stabilization.» The trauma team becomes the primary service for the patient as he or she transitions away from the emergency department. The trauma team must effectively communicate with and serve as the liaison between other specialists as injuries are identified.» emodynamic stability should be closely monitored in patients with pelvic ring injuries, involving the assessment of vital signs, imaging findings, and clinical judgment.» Angioembolization and peritoneal packing may play a role in helping to control hemorrhage.» Urologists should be consulted if a Foley catheter cannot be passed or there is concern for urethral or bladder injury. Further imaging or urologic intervention may be necessary.» Orthopaedic surgeons can help to assess the patient, classify the injury, and assist in temporary stabilization while planning definitive fixation.

BACKGROUND:Hospital readmissions are resource intensive, associated with increased morbidity, and often used as hospital-level quality indicators. The factors that determine hospital readmission after blunt thoracic trauma have not been sufficiently defined. We sought to identify predictors of hospital readmission in patients with traumatic rib fractures. METHODS:We performed an 8-year (2011-2019) retrospective chart review of patients with traumatic rib fractures who required unplanned readmission within 30 days of discharge at a Level 1 trauma center. Patient characteristics, injury severity, and hospital complications were examined using quantitative analysis to identify readmission risk factors. RESULTS:There were 13,046 trauma admissions during the study period. The traumatic rib fracture cohort consisted of 3,720 patients. The cohort included 206 patients who were readmitted within 30 days of discharge. The mean age of the traumatic rib fracture cohort was 57 years, with a 6-day median length of stay. The 30-day mortality rate was 5%. Use of anticoagulation (11.0 vs. 5.4; p = 0.029), diagnosis of a psychiatric disorder (10.2 vs. 5.3; p = 0.01), active smoking (7.3 vs. 5.0; p = 0.008), associated hemothorax (8.3 vs. 5.2; p = 0.010), higher abdominal Abbreviated Injury Scale (33.3 vs. 8.4 vs. 6.5; p = 0.002), rapid response activation (8.9 vs. 5.2; p = 0.005), admission to intensive care unit (7.7 vs. 4.5; p = 0.001), and diagnosis of in-hospital pneumonia (10.1 vs. 5.4; p = 0.022) were predictors of hospital readmission. On multivariate analysis, prescribed anticoagulation (odds ratio [OR], 2.22; p = 0.033), active smoking (OR, 1.58; p = 0.004), higher abdominal Abbreviated Injury Scale (OR, 1.50; p = 0.054), and diagnosis of a psychiatric disorder (OR, 2.00; p = 0.016) predicted hospital readmission. CONCLUSION:In patients with traumatic rib fractures, those with anticoagulant use, those who actively smoke, those with a psychiatric diagnosis, or those with associated abdominal injuries are at the highest risk of rehospitalization following discharge. Quality improvement should focus on strategies and protocols directed toward these groups to reduce nonelective readmissions.

No abstract

Background and hypothesis: The association of abnormal ventricular conduction with co-morbidities and effect of conduction abnormalities on TAVR outcomes have not been well investigated. Methods: A retrospective chart review was conducted in 200 consecutive TAVR patients. ECG data was collected and stratified into normal conduction (WNL, n=138), LBBB (n=25), RBBB (n=20), and intra-ventricular conduction delay (IVCD, n=17). Outcomes were adjudicated according to the PARTNER trial definitions (NEJM 2010; 363: 1597-1607). Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB. Results: There was no association between any conduction delay and history of CVA, PVD, chronic renal disease, smoking, hyperlipidemia, hypertension, or COPD. Conduction delays were associated with decreased ejection fraction (LBBB 45.4+/-2.2, RBBB 50.3+/-1.5, IVCD 48.0+/-3.2 vs. 50.7+/-10.9 in WNL conduction, p= 0.03) and lower aortic valve gradient (LBBB 35.0+/- 3.2 mm Hg, RBBB 42.2+/- 2.9, IVCD 40.5 +/- 5.0 vs. 46.2+/-1.5 in WNL conduction, p= 0.022). Standard error was used as the measure of dispersion. Despite the decreased ejection fraction and lower aortic valve gradient, conduction delays were not associated with an increased incidence of post-TAVR death, re-hospitalizations, stroke, or acute renal failure. Conclusion: Despite association with decreased ejection fraction and lower aortic valve gradient, electrocardiographic conduction delays do not lead to inferior TAVR outcomes.