Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis.

INTRODUCTION: Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes. METHODS: A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24 hours, late >24 hours). RESULTS: Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races. CONCLUSION: Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.

Clinical Impact of Prolonged Helicopter Emergency Travel Times in a Rural Trauma System.

BACKGROUND: In the United States, healthcare organizations utilize helicopter emergency medical services (HEMS), which are well-established and integral to trauma and emergency medical transport. HEMS expedites critical resources to trauma patients at the initial scene of the accident, which typically falls outside of the effective service area of ground transportation. METHODS: This is a single-center study of trauma registry data, inclusive years July 1, 2016, to September 26, 2021. The inclusion criteria were all adult ICU patients (≥18 years) traveling by air. An initial bivariate analysis was used to describe differences in HEMS vs rendezvous (ground + HEMS) mode of arrival. A multivariate linear regression was calculated to predict elapsed transport times on predictor variables to determine the clinical impact of prolonged transport times. RESULTS: There were 242 patients identified in the analysis, with 87 (36%) traveling by HEMS and 155 (64%) traveling by rendezvous. A significant regression equation was found (F(29,198) = 2.39, P < .01), with an R2 of .26. As the transport time increased by 10.67 minutes, the shock index ratio (SIR) increased by one unit (P = .04). Conversely, for each unit increase in Glasgow Coma Scores (GCS), flight time decreased by 1.03 minutes (P < .01). Rendezvous transport times were on average eight minutes longer than HEMS alone (P < .01). CONCLUSIONS: Those with prolonged travel times were likely to travel by rendezvous with presentation of lower GCS and higher SIR upon arrival, despite equivocal injury patterns and severity. This research highlights the need for a helicopter auto-launch program to expedite helicopter travel times in distant locations to the only Level I trauma center in the region.

Service use and costs for persons experiencing chronic homelessness in Philadelphia: a population-based study.

OBJECTIVE: This study is the first to examine the distribution of service utilization and costs with a population-based sample that experienced chronic homelessness in sheltered and unsheltered locations in a large U.S. city. METHODS: This study used shelter and street outreach records from a large U.S. city to identify 2,703 persons who met federal criteria for chronic homelessness during a three-year period. Identifiers for these persons were matched to administrative records for psychiatric care, substance abuse treatment, and incarceration. RESULTS: Twenty percent of the persons who incurred the highest costs for services accounted for 60% of the total service costs of approximately $20 million a year (or approximately $12 million). Most of the costs for this quintile were for psychiatric care and jail stays. Eighty-one percent of the persons in the highest quintile had a diagnosis of a serious mental illness, and 83% of the persons in the lowest quintile had a history of substance abuse treatment without a diagnosis of a serious mental illness. CONCLUSIONS: Supportive housing models for people with serious mental illness who experience chronic homelessness may be associated with substantial cost offsets, because the use of acute care services diminishes in an environment of housing stability and access to ongoing support services. However, because persons with substance use issues and no recent history of mental health treatment used relatively fewer and less costly services, cost neutrality for these persons may require less service-intensive programs and smaller subsidies.

Tracking residential outcomes of supported independent living programs for persons with serious mental illness.

This study seeks to document patterns and reasons of leaving housing, and identify factors associated with different types of exits for a cohort of 452 residents with serious mental illness entering supported independent living (SIL) in Philadelphia, PA. The study cohort was tracked through an integrated administrative database comprised information on basic demographic and clinical characteristics, length of stay, homeless shelter use, and publicly funded behavioral health services use. A convenience sample of 46 SIL leavers and their support staff provided data on scenarios of leaving. The findings of this study suggest that departure from SIL is not a unitary phenomenon, but involving plausibly favorable as well as unfavorable circumstances. Multivariate analysis based on administrative tracking data suggests demographic and clinical factors, housing setting, and service use factors to have effects on leaving SIL and distinct types of exit examined in this study. Data procured from the convenience sample highlight the potential roles that program rules and resident-staff relationships play in affecting housing tenure. Implications of the findings for the development of permanent supportive housing for persons with serious mental illness are discussed.