A 5-year review of a trauma-trained hospitalist program for trauma patients: A matched cohort study.

BACKGROUND: Level I trauma centers have requirements on the percentage of trauma patients admitted to either a trauma surgeon or surgical subspecialist; however, surgical resources are in steady decline. Therefore, a trauma system might better utilize its surgical resources if trained hospitalists admitted a larger percentage of mild to moderately injured trauma patients. The objective of this report is to provide a 5-year evaluation of a trauma medical service (TMED) at treating mild to moderately injured trauma patients. METHODS: Adult trauma patients consecutively admitted to a Level I trauma center between January 2006 and December 2010 were analyzed. Patients admitted to trauma surgical services were matched 1:1 to those admitted to TMED, via propensity scores. Paired t tests examined differences in hospital duration of stay (DOS), and exact conditional logistic regression examined differences in the odds of having a delayed diagnosis, developing a complication, and dying. RESULTS: Of 1,202 TMED patients, 494 were matched; matched TMED patients had similar patient outcomes to nonmatched TMED patients. There were no differences between study groups in the mean hospital DOS, the proportion having a delayed diagnosis, or in the odds of dying in the hospital (P > .05 for all). The TMED group had a nominally higher complication rate (P = .12) owing to a higher rate of urinary tract infections. CONCLUSION: Since its inception, the TMED service has successfully and safely treated mild to moderately injured trauma patients, and decreased the dependency on trauma surgical services. Trauma centers might utilize declining surgical services more efficiently with the addition of trauma medical hospitalists.

Effects of a nonsurgical hospitalist service on trauma patient outcomes.

BACKGROUND: The American College of Surgeons criteria for Level I trauma centers calls for >90% of trauma patients to be admitted directly by a trauma surgeon or surgical subspecialist; however, the efficiency of the trauma system may be increased if patients presenting with comorbid conditions and minor injuries are treated by a hospitalist team (nonsurgical Trauma MEDical [TMED] service). We hypothesized outcomes would be equivalent for patients treated under TMED versus a surgical service. METHODS: This retrospective review compared mortality, hospital length of stay (LOS), Emergency Department (ED) LOS, placement to rehabilitation facilities, and complication rates for patients who could have been treated by TMED as identified by an algorithm. The study population for 2003 (pre-TMED) was compared with the study population for 2006 (post-TMED). Univariate analyses and multivariate logistic and linear regression were used to identify outcomes that were different for patients treated in 2003 versus 2006. Sensitivity, specificity, and percent kappa agreement were calculated for patients who were treated by the TMED team in 2006 versus patients in 2006 who were identified using the algorithm. RESULTS: The algorithm had reasonable sensitivity (78%) and specificity (90%); the kappa agreement was excellent (0.88). No differences were found in mortality (P = .31), rate of complications (P = .08), ED LOS (P = .77), or placement to rehabilitation facilities (P = .29) for patients identified in 2003 versus 2006. Hospital LOS was increased in 2006 (3.7 vs 4.1 days; P = .02). CONCLUSION: These data support admission of trauma patients with nonsevere, single-system injuries to a nonsurgical hospitalist service. We hypothesize that overall system efficiency may be improved by applying this alternative model in other trauma centers.

Adiposity changes in youth with a family history of cardiovascular disease: impact of ethnicity, gender and socioeconomic status.

OBJECTIVE: The purpose of this study is to describe change in the prevalence of overweightness over time in a cohort of youth with a family history of cardiovascular disease and to determine whether changes in adiposity were influenced in this group by ethnicity, gender, socioeconomic status (SES), or interactions among these factors. METHODS: Two hundred and fifty-three subjects with an average age of 8.8 years +/- 2.0 (SD) at the initial visit and 16.0 years +/- 1.8 SD at follow-up were included in the study. Measures of general adiposity, central adiposity, and peripheral adiposity were obtained at both the initial and follow-up visits. Overweight was defined as having a body mass index (BMI) > the 95th percentile; at risk for overweight was defined as having a BMI between the 85th and 95th percentile for age and gender. RESULTS: The prevalence of overweight among the study group remained stable at about 22%, while the prevalence of at risk for being overweight increased from 8.7% to 17.4%. Nearly 40% of all the participants had a BMI > 85th percentile at follow-up. Lower SES youth demonstrated the largest increases in BMI, standardized BMI, sum of skinfold thickness, waist circumference, and triceps skinfold thickness. CONCLUSIONS: The prevalence of youth at risk for being overweight increases during late childhood and adolescence. Effectively focused primary prevention efforts are needed for at-risk youth to prevent the later development of adiposity-related morbidity.

Changes in overweight in youth over a period of 7 years: impact of ethnicity, gender and socioeconomic status.

OBJECTIVE: To examine changes in overweight in youth over a period of 7 years, within the context of ethnicity, gender, and socioeconomic status (SES). METHODS: Participants in a longitudinal study of cardiovascular (CV) risk factor development were evaluated on 2 occasions an average of 7.2 +/- 0.5 years apart. There were 253 subjects (121 Blacks, 132 Whites, 130 females) with a mean age of 8.8 +/- 2.0 years at the initial visit. SES was determined by Hollingshead Social Status Index and was categorized as low, middle (+/-1 standard deviation from mean), and high. Overweight was defined as >85th percentile in Body Mass Index (BMI) for age and gender (National Health and Nutrition Examination Survey [NHANES] norms). RESULTS: Standardized BMI increased significantly over the course of the study (P<.001). The increase was not significantly different by ethnicity or by gender (both P values>.05) but did significantly differ by SES (P<.001). Overall, the prevalence of overweight increased from 31% to 40% (P<.001); however, for those with low SES, the prevalence increased from 37% to 67% (P<.001). CONCLUSION: Lower SES youth, regardless of ethnicity or gender, exhibited extremely large increases in general adiposity over time and are at particular risk for development of a number of obesity-related problems, such as hypertension. Primary prevention of obesity is needed in youth, particularly among those from low SES backgrounds.