Resource utilization and outcomes of intoxicated drivers.

BACKGROUND: The high risk behavior of intoxicated drivers, impaired reaction time, lack of seat belt use, and increased incidence of head injury raises questions of whether pre-hospital use of alcohol leads to a higher injury severity score and worse clinical outcomes. We therefore compared intoxicated and non-intoxicated drivers of motor vehicle crashes with respect to outcome measurements and also describe the resources utilized to achieve those outcomes at our Level 1 trauma center. METHODS: Retrospective descriptive study (Jan 2002-June 2007) of our trauma registry and financial database comparing intoxicated drivers with blood alcohol levels (BAC) > 80 mg/dl (ETOH > 80) with drivers who had a BAC of 0 mg/dl (ETOH = 0). Drivers without a BAC drawn or who had levels ranging from 1 mg/dL to 80 mg/dL were excluded. Data was collected on demographic information (age, gender, injury severity score or ISS), outcome variables (mortality, complications, ICU and hospital LOS, ventilator days) and resource utilization (ED LOS, insurance, charges, costs, payments). STATISTICAL ANALYSIS: p < 0.05 vs. ETOH > 80; stratified chi square. RESULTS: Out of 1732 drivers, the combined study group (n = 987) of 623 ETOH = 0 and 364 ETOH > 80 had a mean age of 38.8 +/- 17.9, ISS of 18.0 +/- 12.1, and 69.8%% male. There was no difference in ISS (p = 0.67) or complications (p = 0.38). There was a trend towards decreased mortality (p = 0.06). The ETOH = 0 group had more patients with a prolonged ICU LOS (>/= 5 days), ventilator days (>/= 8 days), and hospital LOS (> 14 days) when compared to the ETOH > 80 group (p < 0.05). The ETOH > 80 group tended to be self pay (4.9% vs. 0.7%, p < 0.5) and less likely to generate payment for hospital charges (p < 0.5). Hospital charges and costs were higher in the ETOH = 0 group (p < 0.5). CONCLUSIONS: The data suggests that intoxicated drivers may have better outcomes and a trend towards reduced mortality. They appeared to be less likely to have prolonged hospital LOS, ICU LOS, and ventilator days. We also observed that intoxicated drivers were more likely to be self-pay, less likely to have charges > $50K, and less likely to pay >/= 90% of the charges. Further research using multivariable analysis is needed to determine if these apparent outcomes differences are driven by acute intoxication, and the tendency for endotracheal intubation and ICU admission, rather than injury severity.

Outcome assessment of blunt trauma patients who are undertriaged.

BACKGROUND: We investigated the outcomes of injured patients who were undertriaged and compared them with those meeting full trauma team activation (TTA) criteria. METHODS: Blunt trauma patients (July 2002-January 2008) meeting full TTA criteria and had a partial TTA were in the undertriage group (UTG). Data was collected on demographics, injury severity, OR delays, resource utilization, and outcomes. Excluded: penetrating trauma, transfers, burns, age <18 years. STATISTICS: Chi square, P < .05, mean +/- SD. RESULTS: One thousand four hundred and twenty-four patients with 318 (22.3%) in the UTG and 1,106 in the correctly triaged group (CTG). The CTG was 70.4% male (vs 67.1%; P = .26), 41.5 +/- 19.8 years old (vs 45.8 +/- 20.5; P < .01), and had an injury severity score (ISS) of 24.7 (vs 17.0; P < .0001). The CTG was more likely to require ED intubation (34.9% vs 8.2%; P < .0001), ICU admission (49.0% vs 37.1%; P < .0001), longer ICU/hospital LOS, and more ventilator days (P < .0001) with no differences in OR delays. The UTG had a lower mortality (6.0% vs 16.7%; P < .0001) and were discharged home more often (65.3% vs 52.2%; P = .02). CONCLUSION: The UTG had a lower ISS and improved outcomes compared to the CTG with no differences in OR delays. Despite inherent challenges in TTA protocols, patients who were undertriaged at our institution appear to have satisfactory outcomes.

Prophylactic inferior vena cava filters: do they make a difference in trauma patients?

BACKGROUND: Inferior vena cava filters (IVCF) are used in trauma patients to reduce the incidence of pulmonary embolism (PE). This study investigates the efficacy of prophylactic IVCF (PIVCF) placement from implantation through outpatient follow-up. METHODS: Data were prospectively collected on PIVCF placed in trauma patients > or =18-years old from 2004 to 2006. Exclusion criteria include therapeutic IVCF, major burns, deviated from a modified EAST protocol, and deaths. Data were collected on age, gender, Injury Severity Score (ISS), filter type, total implant days, PE, deep venous thrombosis (DVT), and filter-related complications. STATISTICAL ANALYSIS: p < 0.05*, chi square test, mean +/- SD. RESULTS: Of 4,936 patients, 280 had an IVCF with 244 meeting inclusion criteria. Study group demographics: 63.5% men; 98.8% blunt; mean age 43.8 +/- 20.3; ISS 26.7 +/- 12.8. There were 176 of 244 (72.1%) patients who met traditional EAST guidelines for PIVCF. PIVCF increased significantly from 29 in 2004 to 127 in 2006 with no difference in the PE rate (0.7% to 0.4%). There were 4 PEs (1.6%) on postprocedure days 7, 14, 18, and 23. Five technical complications occurred: two filter fractures, two caudal migrations, and one filter tilt. A total of 140 retrievable filters had the opportunity for outpatient follow-up for 18 months with 58.6% removed, 15.7% declared permanent, 12.1% lost to follow-up, and 13.6% still considered potential removal candidates. Days to implant: 0 to 32; 3.89 +/- 4.79. Implant days: 15 to 838; mean 231 +/- 162. CONCLUSIONS: PIVCF increased significantly without impacting the overall PE rate. There was a 1.6% PE rate among PIVCF, high retrieval rate (59%), low complication rate (0.1%), and satisfactory compliance with traditional EAST guidelines.