The Utility of MRI in Cervical Spine Clearance in Alert Blunt Trauma Patients with Cervical Spine Tenderness and Negative CT Scan

Study Objective: To evaluate the utility of MRI of the cervical spine in alert blunt trauma patients with a GCS of 15 without any neurological deficits who have cervical spine tenderness and a negative CT scan

It\u27s All Fun and Games Until Someone Gets Hurt: An Analysis of Trampoline Injuries in the Pennsylvania Trauma System

Introduction: It is well known that trampolines can be a particular source of danger, especially in children. We sought to examine the profile of those patients with trampoline injuries. We hypothesized there would be certain injury patterns predicative of trampoline injuries. Methods: All patients submitted to Pennsylvania Trauma Outcome Study (PTOS) database from 2016-2018 were analyzed. Trampoline injury was determined by ICD10 activity code. Injury patterns in the form of abbreviated injury scale (AIS) body regions were examined in the trampoline injured patients. Patient demographics and clinical variables were compared between those with trampoline injury versus those without. Results: There were 107 patients from 2016-2018 in PTOS who had a trampoline injury. All of these patients were discharged alive and had a blunt mechanism of injury. Of the 107 patients, the most common injury type was injury to the extremities (90/107 patients [84.1%]) with 54 (50.5%) patients having upper extremity injury and 36 (33.6%) patients having lower extremity injury. 10 (9.35%) patients had injury to the spine and 5 (4.67%) had head injury. Those with trampoline injuries were significantly younger (mean age: 13.0 vs. 48.6) and more likely to be white or of Hispanic ethnicity. Almost half of the patients injured (49.5%) were under 10 years of age. Patients with trampoline injuries had significantly lower injury severity scores and significantly higher Shock Index (Table 1). Conclusions: The majority of patients with trampoline injuries had injury to an extremity and were pediatric patients. These results help better understand the demographic, physiologic and anatomic patterns surrounding trampoline injuries. Current government standards recommend that no child under age 6 should use a full-sized trampoline; however, based off of the study results, we advise that this age be increased to 10

Funiculitis mimicking appendicitis: A rare culprit

Acute appendicitis is an extremely common cause for pediatric admissions, most notably presenting with right lower quadrant pain. There are few other etiologies for a young male to have pain aside from appendicitis. We present a young boy who presented with right lower quadrant abdominal pain and fevers, but was found to have funiculitis. Funiculitis, or inflammation of the spermatic cord, is a very rare condition in the pediatric population, almost always occurring in the elderly with urinary flow conditions. We share our case to remind providers the importance of a full differential diagnosis

The Utility of MRI in Cervical Spine Clearance in Neurologically Impaired Blunt Trauma Patients with a Negative CT Scan

Study Objective:To evaluate the utility of MRI of the cervical spine in neurologically impaired blunt trauma patients with a GCS of 14 or less without gross motor deficits who have a negative CT scan

An overview of Amish mortalities at a level I trauma center

Background: The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. Materials and Methods: All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-4/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. Results: There were 1,827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top three mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%) and farming accidents (15.6%). Pediatric (age ≤14y) (25%) and geriatric (age ≥65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs. 27 years, p=0.003) and had significantly higher ISS (mean ISS: 29 vs 10, p Discussion: The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done highlighting this particular cause of mortality

A Statewide Analysis of Pediatric Liver Injuries Treated at Adult Versus Pediatric Trauma Centers.

INTRODUCTION: Hemodynamically normal pediatric trauma patients with solid organ injury receive nonoperative management. Prior research supports that pediatric patients have higher rates of nonoperative management at pediatric trauma centers (PTCs). We sought to evaluate differences in outcomes of pediatric trauma patients with liver injuries. We hypothesized that the type of trauma center (PTC versus adult trauma center [ATC]) would not be associated with any difference in mortality. METHODS: The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003 to 2018 for all patients (y) with liver injuries by International Classification of Disease 9 and 10 codes. Patients were categorized based on admission to the PTC or ATC. The primary endpoint was mortality with secondary endpoints being operative intervention and length of stay. Multivariate logistic regressions assessed the adjusted impact on mortality and surgical intervention. RESULTS: Of the 1600 patients with liver trauma, 607 met inclusion criteria. A total of 78.4% were treated at PTCs. Patients underwent hepatobiliary surgery more frequently at ATCs (11.5% [n = 15] versus 2.74% [n = 13], P \u3c 0.001). Adjusted analysis showed lower odds of surgical intervention for hepatobiliary injuries at PTCs (adjusted odds ratio: 0.17, P = 0.001). There was a decrease in mortality at PTCs versus ATCs (adjusted odds ratio: 0.38, P = 0.032). CONCLUSIONS: Our statewide analysis showed that pediatric trauma patients with liver injuries treated at ATCs were associated with having higher odds of mortality and higher incidence of operative management for hepatobiliary injuries than those treated at PTCs. In addition, between centers, patients had similar functional status at discharge

Frailty is associated with worse outcomes in geriatric pelvic fractures

INTRODUCTION: Frail, geriatric patients with pelvic fractures can present differently than their non-frail counterparts. Using the Clinical Frailty Scale (CFS), a retrospective analysis was conducted to determine the relationship between patients’ CFS and outcomes after pelvic fractures. We hypothesized that frail (F), geriatric trauma patients with pelvic fractures would have worse outcomes than their non-frail (NF) counterparts. METHODS: All geriatric (≥ 65y) patients with pelvic fractures and a documented frailty score from 2019-2021 at our Level I trauma center were analyzed. Frailty was measured using the Clinical Frailty Scale. A score of 1 = Very Fit, 2 = Well, 3 = Managing Well, 4 = Vulnerable, 5 = Mildly Frail, 6 = Moderately Frail, 7 = Severely Frail, 8 = Very Severely Frail, and 9 = Terminally Ill. We defined a clinical frailty score of \u3e 4 as F and ≤ 4 as NF. Frailty score, demographic, clinical, and outcome variables were compared between F and NF geriatric pelvic fracture patients. RESULTS: There were 70 patients included in the study. 41 (59%) of these patients were frail. All patients had blunt mechanisms of injury. There was no difference in mortality. The Frail group were older. Frail were most likely to be discharged to a skilled nursing facility (65.8% of F), while NF were most likely to be discharged to acute rehab (52% of NF). F had lower functional status at discharge (FSD) than NF (14.5 vs. 16, p=0.015). DISCUSSION: F patients with pelvic fractures have worse outcomes than NF in this preliminary patient population of geriatric frail pelvic fracture patients. These patients, when compared to their NF counterparts, tend to be older, have lower FSD, and more often discharge to a skilled nursing facility. Special attention should be focused on this vulnerable population to ensure they receive optimal treatment

Clotting Propensity in Trauma Patients According to Marijuana Use: A Descriptive Analysis

Marijuana use has been reported to promote hypercoagulable states among trauma patients, particularly respecting venous thromboembolism (VTE), a major contributor to morbidity and mortality in patients sustaining traumatic injury. We sought to investigate this further through a retrospective, single institutional study performed from January 2018 through June 2021, utilizing data from patients presenting to a Level 1 Trauma Center as a trauma activation. We observed less frequent VTE development in the marijuana-positive group compared to the marijuana-negative group, with patient thromboelastography revealing a longer mean R-time in the marijuana-positive group. Overall occurrence of VTE was too low for definitive conclusions, but a trend towards reduction in VTE frequency among marijuana users compared to nonusers was noted. More studies with larger populations and more VTE occurrences are needed to confirm a potential correlation between marijuana use and VTE development

Geriatric Motorcycle-Related Outcomes: A Pennsylvania Multicenter Study

Introduction: Geriatric patients (GP) often experience increased morbidity and mortality following traumatic insult and as a result, require more specialized care due to lower physiologic reserve and underlying medical comorbidities. Motorcycle injuries (MCC) occur across all age groups, however, no large-scale studies evaluating outcomes of GP exist with data thus far limited to recreational based studies. We hypothesized that geriatric MCC will face worse outcomes and utilize more hospital resources despite greater helmet usage compared with their younger counterparts. Methods: We performed multicenter retrospective review of MCC patients at three Pennsylvania level I trauma centers from January 2016 to December 2020. Data was extracted from each institution’s electronic medical records and trauma registry. GP were defined as patients greater than or equal to 65 years of age. The primary outcome was mortality. Secondary outcomes included ventilator days (VD) and hospital (HLOS), intensive care unit (ICU LOS), and intermediate unit (IMU LOS) length of stays. 3:1 [(nongeriatric patients (NGP) to GP] propensity score matching (PSM) was based on sex, abbreviated injury scale (AIS) and injury severity score (ISS). p≤0.05 was considered significant. Results: 1538 (GP:7%[n=113]; NGP:93%[n=1425]) patients were included. Median ISS (GP:10 vs NG:6), median Charleston Comorbidity Index (GP:3 vs NGP:0), and helmet usage (GP:76.9% vs NGP:58.8%) were higher in GP (p≤0.05), however, mortality rates were similar (GP:1.7% vs NGP:2.6%; p=0.99). Following PSM (n=488), GP had significantly more comorbidities (p≤0.05). There was no difference in trauma bay interventions or complications between cohorts. Mortality remained similar between cohorts post-PSM (GP:1.8% vs NGP:3.2%; p=0.417). Differences in ventilator days as well as ICU LOS, IMU LOS and HLOS were negligible. Helmet usage (GP:64.5% vs NGP:66.8%; p=0.649) and insurance status (GP:87.4% vs NGP:91.5%; p=0.189) between groups were similar. Helmet use was more prevalent among insured NGP compared with those without insurance (69.1% vs 46.2%; p≤0.05). Conclusion: When matched for sex, ISS and AIS, age was not associated with interventions, complications, ventilator days, length of stay or mortality. There was no significant difference in helmet usage or insurance status between groups. Based on our study, there is no strong evidence for altering initial management of motorcycle-related trauma in geriatric patients