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Topics
- Brain Injury (2)
- Care Coordination (1)
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- Transitions of Care (1)
- (-) Trauma (17)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedScaife JH, Bryce JR, Iantorno SE
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
The term “Undertriage” refers to the treatment of patients at facilities lacking in the equipment needed to treat the patient's injuries appropriately. The purpose of this retrospective cohort study was to assess the relationship between patient and hospital characteristics and secondary undertriage in children after major trauma. The researchers utilized the 2019 Nationwide Emergency Department Sample and included patients aged less than 18 years of age if they presented to a Level 3 or non-trauma center (NTC) and were diagnosed with a traumatic injury with an injury severity score of greater than 15 based on International Classification of Diseases 10 codes. The study found that of 6,572 weighted patients, 15% were undertriaged. Undertriage was significantly associated with older age, metropolitan location, and major abdominal injuries. After multivariable adjustment, secondary undertriage was significantly associated with patients aged 6-10 years of age compared to patients aged 15-17 years, penetrating injury, major chest injury, and presentation at a teaching hospital.
AHRQ-funded; HS025776.
Citation: Scaife JH, Bryce JR, Iantorno SE .
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
J Surg Res 2024 Jan; 293:37-45. doi: 10.1016/j.jss.2023.07.054..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Injuries and Wounds
Nguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
AHRQ-funded; HS025720.
Citation: Nguyen JK, P P .
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Kaufman EJ, Khatri U, Hall EC
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
This study surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of law enforcement officer (LEO) presence in trauma bays nationwide. The survey was distributed electronically to AAST members in September and October 2020, with 234 responding. Of those respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEOs helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents. Respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety when determining LEO access.
AHRQ-funded; HS026372.
Citation: Kaufman EJ, Khatri U, Hall EC .
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
Trauma Surg Acute Care Open 2023 Mar 13;8(1):e001022. doi: 10.1136/tsaco-2022-001022.
Keywords: Trauma, Emergency Department
Piantino JA, Lin A, Luther M
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
This study’s objective was to determine the clinical value of using changes in heart rate variability (HRV) and electroencephalographic (EEG) background in children with acute trauma seen in the Emergency Department (ED) as early predictors of outcome. A novel wireless monitoring device was piloted in 17 patients with 15 patients having EEG data rated as appropriate for clinical interpretation. This was compared to EEG and HRV data successfully collected in 167 subjects. Results showed recording early HRV and EEG is feasible in children with acute injury. This new tool may offer an early, non-invasive marker for injury stratification and prognosis in children.
AHRQ-funded; HS022981.
Citation: Piantino JA, Lin A, Luther M .
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
J Child Adolesc Trauma 2021 Jun;14(2):165-75. doi: 10.1007/s40653-020-00313-1..
Keywords: Children/Adolescents, Emergency Department, Trauma, Outcomes
Azadani EN, Townsend J, Peng J
The association between traumatic dental and brain injuries in American children.
This study examined the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBIs) among children ages 0-18 years. The Nationwide Emergency Department Sample (NEDS), an HCUP dataset, was analyzed using ICD-9-CM codes for the 2010-2014 NEDS data. Out of 6,281,658 emergency department (ED) visits, DAT was recorded in 93,408 (1.5%) visits and TBI was recorded in 996,334 (15.9%) visits. Of the DAT-positive encounters, 7.5% had codes associated with TBI. Patients with DAT had 0.20 odds of having TBI compared with patients who did not DAT when all confounding variables were kept constant. Multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT.
AHRQ-funded; HS24263.
Citation: Azadani EN, Townsend J, Peng J .
The association between traumatic dental and brain injuries in American children.
Dent Traumatol 2021 Feb;37(1):114-22. doi: 10.1111/edt.12611..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Neurological Disorders, Dental and Oral Health
Morris RS, Davis NJ, Koestner A
Redefining the trauma triage matrix: the role of emergent interventions.
In this retrospective study, researchers compared the effectiveness of the need for an emergent intervention within 6 h (NEI-6) with existing definitions. Using data from the Michigan Trauma Quality Improvement Program, they found that NEI-6 performs better than trauma triage matrix, need for trauma intervention, and secondary triage assessment tool in terms of under-triage, mortality and need for resource utilization. Other methods resulted in significantly more full-tiered trauma team activations than NEI-6 without identifying patients at risk for early mortality. They concluded that NEI-6 represents a novel tool to determine trauma activation appropriateness.
AHRQ-funded; HS026379.
Citation: Morris RS, Davis NJ, Koestner A .
Redefining the trauma triage matrix: the role of emergent interventions.
J Surg Res 2020 Jul;251:195-201. doi: 10.1016/j.jss.2019.11.011..
Keywords: Trauma, Emergency Department, Healthcare Delivery
Myers SR, DeSimone JD, Lorch SA
US hospital type and proximity to mass shooting events.
This study used data on mass shootings to examine the proximity of adult trauma centers, pediatric trauma centers (TCs), and non–trauma center hospitals to such events. The investigators concluded that based on the data, to ensure the success of trauma care everywhere, all hospitals regardless of TC status should expect and prepare for the eventuality of a mass-casualty event involving both adults and children. All hospitals must be ready to serve as the combat forward-field hospital.
AHRQ-funded; HS023806.
Citation: Myers SR, DeSimone JD, Lorch SA .
US hospital type and proximity to mass shooting events.
JAMA Surg 2020 May;155(5):446-7. doi: 10.1001/jamasurg.2020.0095..
Keywords: Hospitals, Trauma, Emergency Department, Emergency Preparedness
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Meagher AD, Lin A, Mandell SP
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Researchers conducted a retrospective cohort study to identify injured older adults at highest risk for 30-day mortality. They found that older, injured adults transported by EMS to a large variety of trauma and non-trauma hospitals were more likely to die within 30 days if they required emergent airway management or had a higher comorbidity burden. They concluded that identification of an ideal prognostic tool remains elusive.
AHRQ-funded; HS023796.
Citation: Meagher AD, Lin A, Mandell SP .
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Acad Emerg Med 2019 Jun;26(6):621-30. doi: 10.1111/acem.13727..
Keywords: Elderly, Trauma, Mortality, Injuries and Wounds, Emergency Department
Durojaiye AB, Levin S, Toerper M
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.
This study electronic health record (EHR) data to compare usage patterns from pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The data was used to compare demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS). Three distinct groups were compared: fully connected, partially connected, and disconnected. The fully connected group had a decreased ED LOS compared with the partially connected group.
AHRQ-funded; HS023837.
Citation: Durojaiye AB, Levin S, Toerper M .
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.
J Am Med Inform Assoc 2019 Jun;26(6):506-15. doi: 10.1093/jamia/ocy184..
Keywords: Children/Adolescents, Trauma, Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Healthcare Utilization
Vogel JA, Gannon Sungar W, Boatright D
Denver ED Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients.
This study examined the success of the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and the need for specialized healthcare resources for trauma patients. Outcomes measured included intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures and costs. They included 3000 patients with 71% of them male, a median age of 42, and median injury severity score of 9 (IQR 5-16). Of that total, 46% were admitted to the ICU and 4% died. The tool was found to successfully predict healthcare resource utilization and can be used to identify patients early after injury that will require specialized trauma care.
AHRQ-funded; HS023901.
Citation: Vogel JA, Gannon Sungar W, Boatright D .
Denver ED Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients.
Am J Emerg Med 2019 Jun;37(6):1108-13. doi: 10.1016/j.ajem.2018.08.073..
Keywords: Emergency Department, Healthcare Utilization, Outcomes, Trauma
Durojaiye AB, McGeorge N, Kristen W
Characterizing the utilization of the problem list for pediatric trauma care.
The EHR problem list has the potential to support care coordination among the multidisciplinary care team that cares for pediatric trauma patients. To realize this potential, the need exists to ensure appropriate utilization by formulating acceptable usage and management policy. In this regard, understanding the prevailing utilization pattern is pivotal. To this end, in this study, the investigators analyzed EHR in tandem with trauma registry data at a Level I pediatric trauma center.
AHRQ-funded; HS023837.
Citation: Durojaiye AB, McGeorge N, Kristen W .
Characterizing the utilization of the problem list for pediatric trauma care.
AMIA Annu Symp Proc 2018 Dec 5;2018:404-12..
Keywords: Care Coordination, Children/Adolescents, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Hospitals, Registries, Trauma
Chen C, Peng J, Sribnick EA
Trend of age-adjusted rates of pediatric traumatic brain injury in U.S. emergency departments from 2006 to 2013.
The objective of this study was to use the 2006(-)2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of age-adjusted rates of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments. The investigators found that the overall age-adjusted rates of pediatric TBI-related emergency department (ED) visits increased from 2006 to 2013, which was largely caused by pediatric mild TBIs, especially unspecified injury to the head (ICD-9-CM code 959.01) and concussion.
AHRQ-funded; HS024263.
Citation: Chen C, Peng J, Sribnick EA .
Trend of age-adjusted rates of pediatric traumatic brain injury in U.S. emergency departments from 2006 to 2013.
Int J Environ Res Public Health 2018 Jun 5;15(6). doi: 10.3390/ijerph15061171..
Keywords: Brain Injury, Children/Adolescents, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Trauma
Vogel JA, Newgard CD, Holmes JF
Validation of the Denver emergency department trauma organ failure score to predict post-injury multiple organ failure.
The objective of the study was to externally validate the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, a 6-item instrument that includes age, intubation, hematocrit, systolic blood pressure, blood urea nitrogen, and white blood cell count, which was designed to predict the development of multiple organ failure (MOF) within 7 days of hospitalization. It was determined that the Denver ED TOF Score predicted development of MOF within 7 days of hospitalization.
AHRQ-funded; HS017526; HS023901.
Citation: Vogel JA, Newgard CD, Holmes JF .
Validation of the Denver emergency department trauma organ failure score to predict post-injury multiple organ failure.
J Am Coll Surg 2016 Jan;222(1):73-82. doi: 10.1016/j.jamcollsurg.2015.10.010.
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Keywords: Emergency Department, Trauma, Decision Making, Risk, Injuries and Wounds
Vickers BP, Shi J, Lu B
Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers.
The researchers used National Emergency Department Sample (NEDS) data to explore the hypothesis that severely injured trauma victims properly triaged to a level I or level II trauma center have significantly lower odds of death than those undertriaged to a non-trauma center. They found that trauma patients with Injury Severity Score of greater than 25 received most benefit from proper triage. Efforts to reduce undertriage should focus on this population.
AHRQ-funded; HS022277.
Citation: Vickers BP, Shi J, Lu B .
Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers.
Am J Emerg Med 2015 Sep;33(9):1158-65. doi: 10.1016/j.ajem.2015.05.010..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Trauma, Comparative Effectiveness, Mortality
Peng J, Wheeler K, Shi J
Trauma with Injury Severity Score of 75: are these unsurvivable injuries?
This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Its results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified.
AHRQ-funded; HS022277.
Citation: Peng J, Wheeler K, Shi J .
Trauma with Injury Severity Score of 75: are these unsurvivable injuries?
PLoS One 2015 Jul 31;10(7):e0134821. doi: 10.1371/journal.pone.0134821..
Keywords: Mortality, Healthcare Cost and Utilization Project (HCUP), Trauma, Emergency Medical Services (EMS), Emergency Department
Easter JS, Haukoos JS, Claud J
Traumatic intracranial injury in intoxicated patients with minor head trauma.
This study to estimate the prevalence of intracranial injury following minor head injury found that 8% of 225 intoxicated patients with minor head injury had clinically important injuries requiring either hospital admission or neurosurgical followup. Neither the Canadian CT Head Rule nor NEXUS criteria had adequate sensitivity to be used with these patients.
AHRQ-funded; HS019464; HS017526
Citation: Easter JS, Haukoos JS, Claud J .
Traumatic intracranial injury in intoxicated patients with minor head trauma.
Acad Emerg Med. 2013 Aug;20(8):753-60. doi: 10.1111/acem.12184..
Keywords: Emergency Department, Trauma, Brain Injury, Decision Making