Direct oral anticoagulants compared with warfarin in patients with severe blunt trauma.

METHODS: We queried our Trauma Quality Improvement Program registry for patients who presented between 6/1/2011 and 9/1/2015 with severe (injury severity score (ISS)>15) blunt traumatic injury during anticoagulant use. Patients were then grouped into those prescribed warfarin and patients prescribed any of the available novel Direct Oral Anticoagulants (DOAC) medications. We excluded severe (AIS≧4) head injuries. RESULTS: There were no differences between DOAC and warfarin groups in terms of age, gender mean ISS, median hospital or intensive care unit lengths of stay, complication proportions, numbers of complications per patient, or the proportion of patients requiring transfusion. Finally, excluding patients who died, the observed proportion of discharge to skilled nursing facility was similar. In our sample of trauma patients, DOAC use was associated with significantly lower mortality (DOAC group 8.3% vs. warfarin group 29.5%, p<0.015). The ratio of units transfused per patient was also lower in the DOAC group (2.8±1.8 units/patient in the DOAC group vs. 6.7±6.4 units per patient in the warfarin group; p=0.001). CONCLUSION: In conclusion, we report an association with decrease in mortality and a decrease in transfused blood products in severely injured trauma patients with likely minimal or no head injury taking novel DOACs over those anticoagulated with warfarin for outpatient anticoagulation.

Use of a Modified American College of Surgeons Trauma Quality Improvement Program to Enhance 30-Day Post-Trauma Readmission Detection.

BACKGROUND: Traumatic injury remains the leading cause of preventable morbidity and mortality worldwide, with a large economic burden. One fourth of annual Medicare expenditures result from readmissions, including trauma. The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) has elevated care for >200 trauma programs worldwide. We use ACS TQIP, which does not include 30-day outcomes featured in the ACS NSQIP, affecting observed readmission rates. STUDY DESIGN: Trauma patients were subjected to the 30-day follow-up with the ACS NSQIP tools to assess readmission rates. The existing standard hospital and trauma registry data review was used to determine readmission, with the same group assessed for readmission using the information collected with the modified TQIP tools. All data collected via this method were patient reported and verified by review of records at our facility and via patient-authorized outside record review. RESULTS: Six hundred and ninety-eight consecutive patients were admitted to the trauma service during the study period and 378 (54.1%) were contacted by telephone for interview. Demographic characteristics were similar (p = NS). The readmission rate changed from 4.01% to 2.4% using the hospital and trauma registry subset (p = NS). Readmission rate by the modified TQIP method was 7.1% (p < 0.03). Readmitted patients did not differ with respect to routine follow-up visits. CONCLUSIONS: We hypothesized that our observed and actual readmission rates differed. We discovered a significant difference in reported rates. Incorporating an NSQIP-like postdischarge feedback process can improve the accuracy of hospitals' readmission data and complication reporting, and thereby improve the value of the information TQIP uses as benchmarks.

Is an Incidental Meckel's Diverticulum Truly Benign?

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract and it is found to affect nearly 2 percent of the population. Interestingly, the surgical management of an asymptomatic Meckel's diverticulum remains widely controversial in the adult population. Review of the literature finds the overall risk of Meckel's diverticulum becoming symptomatic to be low; however, the risk accompanying its resection also proves to be minimal thus perpetuating the question of its proper management. We report our experience with an elderly patient who required an emergent operative intervention and was incidentally found to have Meckel's diverticulum. Review of final pathology found Meckel's diverticulum to contain a carcinoid tumor. In our review, the presence of a carcinoid tumor within Meckel's diverticulum is a rare finding, but its incidence may further support the resection of incidentally found asymptomatic Meckel's diverticulum in patients of all ages.

Follow-up survey of participants attending the Advanced Trauma Operative Management (ATOM) Course.

BACKGROUND: The ATOM Course was developed to educate surgeons about the surgical management of penetrating injuries. Its goals are to improve knowledge, self-confidence, and technical competence. METHODS: ATOM participants completed a 25-item questionnaire to assess self-efficacy (SE) for advanced trauma operative management before and immediately after taking the ATOM course. On follow-up, questionnaires were sent to ATOM participants. One was a 7-item survey to assess the value of the ATOM course to surgical practice. Another was the 25-item questionnaire to assess SE. RESULTS: Four items on the survey to assess the value of ATOM had mean scores > or = 4.0 and 3 had mean scores > 3.6. All had modes of 4.0 or greater. For all items, most respondents selected the agree options indicating positive assessments of the ATOM course to their surgical practice. For SE, the pre-ATOM mean SE score was 3.88 and the immediate post ATOM mean SE score was 4.57 (p < 0.05). The follow-up mean SE score was 4.47 indicating maintenance of SE (p > 0.05). CONCLUSIONS: Follow-up data from ATOM participants indicate that respondents believe the ATOM course improved their ability to identify and repair traumatic injuries. They report they use the techniques and knowledge learned in ATOM and confidence remains high after the ATOM course. ATOM is well received as an effective teaching strategy for surgical education for the management of penetrating injuries.