New legislation in New Jersey reduced opioid use among trauma patients.

PURPOSE: In New Jersey, politicians have emphasized the need to attenuate the ongoing opioid epidemic as opioid use disorder can lead to addiction and, in many cases, mortality. New legislation (New Jersey Senate Bill 3) was enacted in 2017 to reduce opioid prescription from 30 days to 5 days for acute pain in both inpatient and outpatient healthcare settings. Therefore, we sought to evaluate if the enactment of the bill influenced the consumption of opioid pain medication at an American College of Surgeons-verified Level I Trauma Center. METHODS: Patients from 2016 to 2018 were compared for differences in average daily inpatient morphine milligram equivalents (MMEs) consumption and injury severity score (ISS), among other parameters. To ensure that changes in pain medication did not affect the quality of pain management, we compared their average pain ratings. RESULTS: Although the average ISS in 2018 was higher than that in 2016 (10.6 ± 0.2 vs 9.1 ± 0.2, p < 0.001), opioid consumption decreased in 2018 without increasing the average pain rating for patients with an ISS of 9 and 10. More specifically, the average daily inpatient MMEs consumption dropped from 14.1 ± 0.5 in 2016 to 8.8 ± 0.3 in 2018 (p < 0.001). Even among patients with an average ISS >15, the total MMEs consumed per person decreased in 2018 (116.0 ± 14.0 vs 59.4 ± 7.6, p < 0.001). CONCLUSION: Overall, opioid consumption was lower in 2018 without negatively affecting the quality of pain management. This suggests that the implementation of the new legislation has successfully reduced inpatient opioid use.

Association Between Body Mass Index and Morbidity and Mortality During Hospitalization After Trauma.

BACKGROUND: Literature suggests that unhealthy body mass index is a risk factor for adverse clinical outcomes. OBJECTIVES: To study the association between unhealthy body mass index and morbidity and mortality after trauma using the 2016 American College of Surgeons Trauma Quality Improvement Program database. METHODS: A retrospective review was conducted comparing the normal weight control group to the underweight, overweight, obese, severely obese, and morbidly obese groups for differences in demographic factors, injury severity score, comorbidities, length of stay, and complications. RESULTS: Underweight, overweight, obese, severely obese, and morbidly obese body mass indexes, in comparison to normal weight body mass index, were associated with a higher probability of developing at least one complication after trauma. Additionally, we observed a J-shaped curve when analyzing body mass index and mortality, suggesting that both high and low body mass indexes are positively associated with mortality. In fact, morbidly obese patients had the highest mortality rate, followed by underweight patients (p < .001). Interestingly, however, multivariate logistic regression demonstrated that, compared with normal weight body mass index, overweight and obese body mass indexes were independently associated with 9.6% and 10.5% lower odds of mortality, respectively (p < .001 and p = .001). CONCLUSION: Irrespective of preexisting comorbidities, injury severity score, and mechanism of injury, underweight, overweight, obese, severely obese, and morbidly obese body mass indexes were independently associated with higher risks of morbidity, whereas overweight and obese body mass indexes were associated with lower mortality risks. These findings emphasize the complex relationship between body mass index and clinical outcomes for trauma patients.

Analysis of Transport to an American College of Surgeons Level I Trauma Center.

INTRODUCTION: Efficient patient transportation by ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) to a trauma center is vital for optimal care. We investigated differences between the modes of transport in terms of demographics, injury, scene location, and outcome. SETTING: Morristown Medical Center (MMC), Morristown, NJ METHODS: All 903 trauma admissions in 2016 by advanced life support (ALS) to MMC, a Level I Trauma Center, were retrospectively analyzed. RESULTS: 22% of admissions were HEMS and 78% were GEMS. HEMS patients had higher Injury Severity Scores (ISS) (p<0.001); however, mortality and length of stay were not statistically different. The percentage of pediatric patients transported by HEMS that were discharged home after emergency department evaluation was greater than the older populations (p<0.001). Older age and higher ISS had the largest impact on mortality (p<0.001). CONCLUSION: We believe our current use of HEMS is adequate since patient outcomes between HEMS and GEMS was similar, even though HEMS patients have higher ISS. However, helicopter use in the pediatric population was over-utilized, possibly due to the scarcity of hospitals capable of managing pediatric traumas. Implementation of the Air Medical Prehospital Triage scoring system may also help correct for these unnecessary HEMS transports.

Equestrian trauma: injury patterns vary among age groups.

Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.

Standard computed tomography of the chest, abdomen, and pelvis is sensitive and cost-effective for the detection of fractures of the shoulder girdle.

Computed tomography of the chest, abdomen, and pelvis (CTCAP) has become the mainstay of diagnosis in stable blunt trauma patients. The purpose of this study was to investigate whether standard CTCAP has adequate sensitivity to identify fractures of the scapula, clavicle, and humeral head to replace routine radiographs of the shoulder. A retrospective chart review was carried out from January 1, 2004, to December 31, 2007, at Morristown Memorial Hospital. Inclusion criteria were all shoulder fracture patients in our trauma registry who underwent both a CTCAP and plain radiographs of the injured shoulder. Data were collected for patient age, sex, Injury Severity Score, mechanism of injury, and fracture location. Sensitivity was calculated for each diagnostic modality as well as hospital costs and radiation dose of plain radiographs. A total of 374 charts were reviewed and 98 patients were included in the study with a total of 117 fractures. The sensitivity of trauma CTCAP for scapula fractures was 100 per cent, clavicle fractures 98 per cent, and humeral head fractures 100 per cent. The sensitivity of the shoulder series for scapula fractures was 60 per cent, clavicle fractures 85 per cent, and humeral head fractures 100 per cent. The plain radiographs added $298 in hospital charges and 0.191 mSv of radiation per patient. CTCAP is a sensitive tool for identifying fractures in the shoulder girdle. Therefore, CTCAP can replace the routine radiographs of the shoulder resulting in less total radiation exposure of the trauma patients. This also would lead to lower healthcare cost and better diagnostic workflow.