ABSTRACT
BACKGROUND: Traumatic hip dislocations (THD) are a medical emergency. There is debate whether the painful reduction of a dislocated hip should be first attempted using primary conscious sedation (PCS) or primary general anesthesia (PGA) METHODS: All cases of native THD from 2006 to 2015 in the trauma registry of a level 1 trauma center were reviewed. The primary outcome was successful reduction of the THD. RESULTS: 67 patients had a native, meaning not a hip prosthesis, THD. 34 (50.7%) patients had successful PCS, 12 (17.9%) failed PCS and underwent reduction following PGA. 21 (31.3%) underwent PGA. Patients in the PGA group were more severely injured. Time to reduction greater than 6â¯h was associated with PCS failure (Odds ratio (95% confidence interval) 19.75 (2.06,189.10) pâ¯=â¯0.01). CONCLUSION: Clinicians treating patients with a THD can utilize either PCS or PGA with many patients safely reduced under PCS. However, patients whose hip have been dislocated for more than 6â¯h are at risk for failure with PCS, and are good candidates for PGA.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Conscious Sedation/methods , Emergency Service, Hospital , Hip Dislocation/surgery , Hip Injuries/complications , Intubation, Intratracheal/methods , Adult , Female , Follow-Up Studies , Hip Dislocation/etiology , Hip Injuries/surgery , Humans , Male , Retrospective StudiesABSTRACT
BACKGROUND: Clostridium difficile infection (CDI) is a common cause of healthcare associated infections contributing to morbidity and mortality. Our objective was to evaluate the impact of the implementation of a CDI bundle along with probiotic utilization. METHODS: A retrospective review of trauma admissions from 2008 to 2014 was performed. The CDI bundle was implemented in stages from 2009 through 2014 with probiotics initiated in 2010. The bundle included changes in cleaning practices, education, screening, and contact precautions. RESULTS: 4632 (49%) patients received antibiotics with 21% receiving probiotics. Probiotic use was associated with increased age, male sex, more severely injured, and antibiotic use. CDI incidence decreased from 11.2 to 4.8 per 1000 admissions, pâ¯=â¯.03. Among patients who received antibiotics CDI incidence decreased from 2.2% to 0.7%, pâ¯=â¯.01. CONCLUSIONS: We report the largest series of a CDI bundle implementation including probiotics. During the period of adoption of these interventions, the incidence of CDI decreased significantly.
