Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study.

PURPOSE: The primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center. METHODS: A retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013-2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients. RESULTS: During the 2-year study period, 334 of 2,485 admitted trauma patients presented with major trauma and were included in our study. From the univariate analysis, variables that were found to be independently associated with mortality in undertriaged patients included intubation, Glasgow Coma Scale score, revised trauma score, and dementia. Independent risk factors that were found to be significantly associated with undertriage in severely injured trauma patients included Glasgow Coma Scale score, motor vehicle crash, falls, revised trauma score, systolic blood pressure, heart rate, intubation, and dementia. When a multivariate analysis was performed to evaluate the statistically significant risk factors, dementia was found to be significantly associated with undertriage in severely injured trauma patients. CONCLUSION: Severely injured trauma patients with dementia are at significant risk for undertriage. Early identification of these risk factors while triaging at a level I safety-net trauma center could translate into improved patient outcomes following severe trauma.

Spontaneous compartment syndrome of the upper arm in a patient receiving anticoagulation therapy.

BACKGROUND: Compartment syndrome is a condition in which elevated pressures within an osseofascial compartment cause vascular compromise, leading to ischemia and possible necrosis. It commonly occurs after a traumatic event (e.g., fracture, crush, burn); however, compartment syndrome can happen spontaneously and in any compartment of the body. The objective of this case study is to present the signs and symptoms of upper arm compartment syndrome along with a review of the diagnosis and treatment. CASE REPORT: A 75-year-old man receiving anticoagulation for atrial fibrillation developed compartment syndrome in the extensor compartment of his upper arm, diagnosed by clinical examination with the aid of a venous duplex ultrasound study. CONCLUSION: Although uncommon, spontaneous compartment syndrome can occur, and prompt recognition and intervention are limb- and possibly life-saving.

A case of Takayasu arteritis causing subclavian steal and presenting as syncope.

The American Heart Association website defines syncope as "temporary loss of consciousness and posture." Syncope is a common presentation to the Emergency Department (ED). Although case reports of subclavian steal syndrome (SSS) from Takayasu arteritis (TA) and of TA causing syncope have been rarely reported in the literature, our MEDLINE search revealed no published description of the three entities of SSS, TA, and syncope presenting simultaneously. We then describe a case of a 48-year-old woman who presented to our ED with syncope and was found to have SSS. We describe the patient's hospital course leading to the diagnosis of TA, which is a rare form of vasculitis. Finally, we briefly discuss TA, explain the mechanism of SSS in TA, and outline the diagnostic criteria established by the American College of Rheumatology for TA.