Consistency is Key: Additional Education and Outreach in a Rural Trauma System Reduces Excess Imaging Studies.

BACKGROUND: Repeat imaging for trauma patients is common in rural health care systems after transfer to a tertiary trauma center which subjects patients to increased radiation, excess costs, and delays to definitive care. A previous retrospective review at our regional trauma center found that pre-transfer CT scans were frequently performed with little change in management. To improve this rate, additional emphasis was placed on (1) best imaging practices during Rural Trauma Team Development Courses (RTTDC), (2) management feedback during regional trauma case reviews, and (3) implementation of practice management guidelines for an inter-provider telehealth system. METHODS: Two hundred consecutive adult trauma patients transferred to a regional trauma center were retrospectively evaluated after trauma system improvements were implemented and compared to the previous cohort in the same system as identified by the regional trauma database. RESULTS: 140 (70%) had a pre-transfer CT scan compared to 152 (77.2%) in the prior study (P = .0112). Additionally, 52 (37.1%) of those with pre-transfer CT scans had at least one repeat scan on arrival which decreased from (55.3%) in the prior study (P < .0001). The most common reason for repeat CT scans was incomplete initial imaging. Those with a repeat scan were more likely to have a head injury (51.9% vs 35.8%, P = .0413). DISCUSSION: With regional trauma system maturation and implementation of internal telemedicine guidelines, there was a statistically significant decrease in both pre-transfer as well as repeat CT scans in a rural trauma system. Additional research exploring patient outcomes and cost savings is recommended.

A Single Site, Retrospective Chart Review of Renal Transplant Graft Failure and Mortality Rates Pre and Post COVID-19 Pandemic.

INTRODUCTION: Immunosuppressed patients are at an increased risk of complications from COVID-19. Despite the morbidity and mortality associated with COVID-19, there is little information regarding its effect on post-renal transplant patients. This study investigated the impact of a COVID-19 diagnosis on renal transplant recipients in terms of graft failure and mortality. METHODS: Renal transplant recipients were included if they had a functioning graft between March 2020 and March 2022. COVID-19 test results, duration from COVID-19 to graft failure and mortality, vaccination status, and COVID-19 treatment regimen were recorded and analyzed. RESULTS: There were 175 renal transplant recipients who met study criteria. Of these, 82 patients had documented COVID-19 cases, and 93 patients did not have a documented case. Of the patients who had a COVID-19 positive test, 3 experienced renal graft failure, and 15 experienced mortality. When comparing graft failure rate between the two groups, there was no significant difference. The mortality risk was significantly increased in COVID-19 positive patients (p=0.021). The COVID-19 immunization rate (at least one dose) was 82.5% for renal transplant recipients compared to 77.2% for all of South Dakota. CONCLUSIONS: There was no significant difference in renal graft failure rate between the two groups, but there was a significantly increased mortality risk in patients with COVID-19 positivity.

A Practical Guide to Trauma Resuscitation - Recommendations for Managing Hemorrhagic Shock in the Rural Healthcare Setting.

Traumatic injury is the leading cause of death in individuals under the age of 45 and hemorrhage is the leading cause of preventable death within hours of presentation. This review article on adult trauma resuscitation is intended to be a practical guide for critical access centers. This is accomplished by discussing the pathophysiology and management of hemorrhagic shock.