Is New York State good at managing hollow viscus injury?
Abdominal trauma
Colonic injury
Hollow viscus injury
Population outcomes
SPARCS
Stoma reversal
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
08
09
2021
accepted:
12
12
2021
pubmed:
9
1
2022
medline:
27
8
2022
entrez:
8
1
2022
Statut:
ppublish
Résumé
There are an estimated 100,000 cases of abdominal injury (ABI) in the USA, annually resulting in over $12 billion in direct medical cost and $18 billion in lost productivity. This study assesses the timeliness, safety, and efficacy of the surgical management of abdominal injuries (ABIs), hollow viscus injuries (HVIs), and colonic injuries (CIs) for patients residing in New York State (NYS). Using data from NYS's Statewide Planning and Research Cooperative System (SPARCS), we identified all trauma patients with ABI admitted between 2006 and 2015. We subdivided ABI into HVI and CI using diagnosis and procedure codes and examined processes of care and outcomes adjusting for patient characteristics, injury severity score, structural, and process indicators. We identified 31,043 hospitalized patients with ABI, 71% were incurred from blunt forces. Most patients with ABI (72%) were treated at a Level I/II trauma center (TC) and 7% patients were transferred to Level I/II TC. Failure to be treated at Level I/II TC was associated with 16% increased hazard of death. HVI was diagnosed in 23% of ABI patients (n = 7294); 18% experienced delayed hollow viscus repair (dHVR); dHVR was associated with a 76% increased hazard of death. CI was diagnosed in 9% of ABI patients (n = 2921) and 18% experienced dHVR. Seventy-five percent of CI were repaired primarily (n = 1354). Less than 37% of stomas were reversed by 4 years of index trauma. Most abdominal trauma in NYS was caused by motor vehicle accidents, falls, and assault. dHVR and not being treated at Level I/II TC were associated with worse outcomes. More research is needed to reduce under-triage and delays in the operative treatment of blunt abdominal trauma.
Sections du résumé
BACKGROUND
There are an estimated 100,000 cases of abdominal injury (ABI) in the USA, annually resulting in over $12 billion in direct medical cost and $18 billion in lost productivity. This study assesses the timeliness, safety, and efficacy of the surgical management of abdominal injuries (ABIs), hollow viscus injuries (HVIs), and colonic injuries (CIs) for patients residing in New York State (NYS).
METHODS
Using data from NYS's Statewide Planning and Research Cooperative System (SPARCS), we identified all trauma patients with ABI admitted between 2006 and 2015. We subdivided ABI into HVI and CI using diagnosis and procedure codes and examined processes of care and outcomes adjusting for patient characteristics, injury severity score, structural, and process indicators.
RESULTS
We identified 31,043 hospitalized patients with ABI, 71% were incurred from blunt forces. Most patients with ABI (72%) were treated at a Level I/II trauma center (TC) and 7% patients were transferred to Level I/II TC. Failure to be treated at Level I/II TC was associated with 16% increased hazard of death. HVI was diagnosed in 23% of ABI patients (n = 7294); 18% experienced delayed hollow viscus repair (dHVR); dHVR was associated with a 76% increased hazard of death. CI was diagnosed in 9% of ABI patients (n = 2921) and 18% experienced dHVR. Seventy-five percent of CI were repaired primarily (n = 1354). Less than 37% of stomas were reversed by 4 years of index trauma.
CONCLUSION
Most abdominal trauma in NYS was caused by motor vehicle accidents, falls, and assault. dHVR and not being treated at Level I/II TC were associated with worse outcomes. More research is needed to reduce under-triage and delays in the operative treatment of blunt abdominal trauma.
Identifiants
pubmed: 34997346
doi: 10.1007/s00464-021-08964-3
pii: 10.1007/s00464-021-08964-3
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
6789-6800Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Web-based Injury Statistics Query and Reporting System (WISQARS
Web-based Injury Statistics Query and Reporting System (WISQARS
Trauma Quality Imporovement Program Committee (2016) National trauma data bank annual report 2016. American College of Surgeons, Chicago, IL
Adesanya AA, Ekanem EE (2004) A ten-year study of penetrating injuries of the colon. Dis Colon Rectum 47:2169–2177
doi: 10.1007/s10350-004-0726-5
Harmston C, Ward JBM, Patel A (2018) Clinical outcomes and effect of delayed intervention in patients with hollow viscus injury due to blunt abdominal trauma: a systematic review. Eur J Trauma Emerg Surg 44:369–376
doi: 10.1007/s00068-018-0902-2
Watts DD, Fakhry SM, Group EM-IHVIR (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the east multi-institutional trial. J Trauma 54:289–294
doi: 10.1097/01.TA.0000046261.06976.6A
Neeki MM, Hendy D, Dong F, Toy J, Jones K, Kuhnen K, Yuen HW, Lux P, Sin A, Kwong E, Wong D (2017) Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma. Trauma Surg Acute Care Open 2:e000109
doi: 10.1136/tsaco-2017-000109
National Quality Forum (2019) Population-Based Trauma Outcomes. National Quality Forum, Washington, DC. https://www.qualityforum.org/Publications/2019/05/Trauma_Outcomes_Final_Report.aspx
Stelfox HT, Bobranska-Artiuch B, Nathens A, Straus SE (2010) Quality indicators for evaluating trauma care: a scoping review. Arch Surg 145:286–295
doi: 10.1001/archsurg.2009.289
Moore L, Lavoie A, Sirois MJ, Amini R, Belcaid A, Sampalis JS (2013) Evaluating trauma center process performance in an integrated trauma system with registry data. J Emerg Trauma Shock 6:95–105
doi: 10.4103/0974-2700.110754
Gruen RL, Gabbe BJ, Stelfox HT, Cameron PA (2012) Indicators of the quality of trauma care and the performance of trauma systems. Br J Surg 99(Suppl 1):97–104
pubmed: 22441862
Bergen GS, Chen L-H, Warner M (2008) Injury in the United States: 2007 chartbook. National Center for Health Statistics, Hyattsville, MD
Web-based Injury Statistics Query and Reporting System (WISQARSTM): Injury Center (2018) Matrix of E-code groupings. Centers for Disease Control and Prevention, Atlanta, GA
Tian D (2019) Injury severity score. Accessed August 25, 2021 from https://github.com/dajuntian/InjurySeverityScore
Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27
doi: 10.1097/00005650-199801000-00004
Haas B, Stukel TA, Gomez D, Zagorski B, De Mestral C, Sharma SV, Rubenfeld GD, Nathens AB (2012) The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J Trauma Acute Care Surg 72:1510–1515 (discussion 1515–1517)
doi: 10.1097/TA.0b013e318252510a
Choi J, Carlos G, Nassar AK, Knowlton LM, Spain DA (2021) The impact of trauma systems on patient outcomes. Curr Probl Surg 58:100840
doi: 10.1016/j.cpsurg.2020.100840
Committee on Trauma American College of Surgeons (2014) Resources for optimal care of the injured patient. https://www.facs.org/-/media/files/quality-programs/trauma/vrc-resources/resources-for-optimal-care.ashx . Accessed August 28, 2021
Krug EG, Sharma GK, Lozano R (2000) The global burden of injuries. Am J Public Health 90:523–526
doi: 10.2105/AJPH.90.4.523
Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A, Najarian MP, Valenziano CP, Eastern Asociation for the Surgery of T (2002) Practice management guidelines for the evaluation of blunt abdominal trauma: the east practice management guidelines work group. J Trauma 53:602–615
doi: 10.1097/00005373-200209000-00038
Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF (2006) Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg 30:176–182
doi: 10.1007/s00268-005-0194-7
Ricciardi R, Paterson CA, Islam S, Sweeney WB, Baker SP, Counihan TC (2004) Independent predictors of morbidity and mortality in blunt colon trauma. Am Surg 70:75–79
pubmed: 14964554
Sharpe JP, Magnotti LJ, Weinberg JA, Shahan CP, Cullinan DR, Fabian TC, Croce MA (2013) Applicability of an established management algorithm for colon injuries following blunt trauma. J Trauma Acute Care Surg 74:419–424 (discussion 424–415)
doi: 10.1097/TA.0b013e31827a36e9