July--as good a time as any to be injured.

BACKGROUND: Recent studies have suggested worse outcomes for patients hospitalized during the beginning of the academic calendar, though these findings have not been reproduced among trauma patients. This study compares outcomes of patients during the beginning of the academic year with those at the end of the academic year. METHODS: Retrospective trauma registry analysis of a large urban level I trauma center. Patients admitted during April/May (ENDYEAR group) or July/August (FRESH group) between 1998 and 2007 were included. Demographic and injury parameters were recorded, and outcomes compared including crude mortality, complication rate, length of stay (LOS), and intensive care unit LOS (ICU-LOS). TRISS methodology was used to evaluate risk-adjusted performance. RESULTS: Three thousand sixty-seven patients were included in the FRESH group and 3626 in the ENDYEAR group. Groups were similar in age (36 +/- 17 years and 36 +/- 17 years, p = 0.39) and mean Injury Severity Score (8 +/- 11 and 8 +/- 10, p = 0.85). There was no difference in LOS (4.6 +/- 0.2 days versus 4.5 +/- 0.2 days, p = 0.92) or ICU-LOS (5.6 +/- 0.2 days versus 5.3 +/- 0.2 days, p = 0.96). Per patient complication rates for the FRESH and ENDYEAR groups were 6% and 6% (p = 0.8), total complication rates were 12% and 13% (p = 0.07), and crude mortality was 7% and 6% (p = 0.11), respectively. FRESH and ENDYEAR groups had similar W-Statistics (1.0 and 1.2) and z scores (3.5 and 4.4). CONCLUSION: Outcomes were similar between patients injured at the beginning of the academic year compared with the end of the academic year. Our data does not support the concept of a July effect in level I trauma centers.

Incidence of associated events during the performance of invasive procedures in healthy human volunteers.

Metabolic investigations often utilize arteriovenous sampling and muscle biopsy. These investigations represent some risk to the subject. We examined 369 studies performed in the General Clinical Research Center between January 1994 and May 2003 for events related to femoral catheterization and muscle biopsies. Incidents were further examined by age (younger: 18-59 yr, n=133; and older: 60-76 yr, n=28). There were no clinically defined major complications associated with either procedure. The incidence of femoral catheter repositioning or reinsertion was higher in the older group (25.5 vs. 9.7%). There was no difference in the incidence of premature removal of catheters, ecchymosis or hematoma, or the persistence of pain after discharge. The occurrence of all incidents did not increase with multiple catheterizations. Muscle biopsy was associated with infrequent ecchymosis or hematoma in both groups (1.1 and 3.6% in younger and older groups, respectively). Both procedures entail a small likelihood of a vagallike response (3.3% overall), resulting in nausea, dizziness, and rarely a loss of consciousness. These results indicate that, in skilled hands and a defined clinical setting, the incidents associated with femoral catheterization and muscle biopsy in healthy volunteers are reasonable and largely controllable.