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@#BACKGROUND: Near-infrared spectroscopy (NIRS) non-invasively monitors muscle tissue oxygen saturation (StO2). It may provide a continuous noninvasive measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction (MOD) after severe trauma. We evaluated the correlation between initial StO2 and the development of MOD in multi-trauma patients. METHODS: Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department and meeting standardized trauma-team activation criteria were enrolled in this prospective trial. NIRS monitoring was initiated immediately on arrival with collection of StO2 at the thenar eminence and continued up to 24 hours for those admitted to the Trauma Intensive Care Unit (TICU). Standardized resuscitation laboratory measures and clinical evaluation tools were collected. The primary outcome was the association between initial StO2 and the development of MOD within the first 24 hours based on a MOD score of 6 or greater. Descriptive statistical analyses were performed;numeric means, multivariate regression and rank sum comparisons were utilized. Clinicians were blinded from the StO2 values. RESULTS: Over a 14 month period, 78 patients were enrolled. Mean age was 40.9 years (SD 18.2), 84.4％ were male, 76.9％ had a blunt trauma mechanism and mean injury severity score (ISS) was 18.5 (SD 12.9). Of the 78 patients, 26 (33.3％) developed MOD within the first 24 hours. The MOD patients had mean initial StO2 values of 53.3 (SD 10.3), significantly lower than those of non-MOD patients 61.1 (SD 10.0); P=0.002. The mean ISS among MOD patients was 29.9 (SD 11.5), significantly higher than that of non-MODS patients, 12.1 (SD 9.1) (P<0.0001). The mean shock index (SI) among MOD patients was 0.92 (SD 0.28), also significantly higher than that of non-MODS patients, 0.73 (SD 0.19) (P=0.0007). Lactate values were not significantly different between groups. CONCLUSION: Non-invasive, continuous StO2 near-infrared spectroscopy values during initial trauma resuscitation correlate with the later development of multiple organ dysfunction in this patient population.
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BACKGROUND: This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS: Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument. Participants indicated their levels of residency education dedicated to documentation, billing/coding, core measure/quality indicator compliance, and operations management. Data were analyzed using descriptive statistics for the ordinal data / Likert scales.RESULTS: One hundred and six (106) program directors completed the study instrument of one hundred and fifty-six (156) programs (70％). Of these, 82.6％ indicated emergency department (ED) operations and management education within the training curriculum. Dedicated documentation training was noted in all but 1 program (99％). Program educational offerings also included billing/coding (83％), core measure/quality indicators (78％) and operations management training (71％). In all areas, the most common means of educating came through didactic sessions and direct attending feedback or 69％-94％ and 72％-98％ respectively. Residency leadership was most confident with resident understanding of quality documentation (80％) and less so with core measures (72％), billing/coding/RVUs (58％), and operations management tools (23％).CONCLUSIONS: While most EM residency programs integrate basic operational education related to documentation and billing/coding, a smaller number provide focused education on the day-to-day management and operations of the ED. Residency leadership perceives graduating resident understanding of operational management tools to be limited. All respondents value further resident curriculum development of ED operations and management.