The Association of Time to Palliative Medicine Consultation on Geriatric Trauma Outcomes.

The integration of specialized geriatric providers with trauma services has received increased attention with promising results. Palliative medicine consultation (PMC) has been shown to reduce length of stay, improve symptom management, and clarify advance directives in the geriatric trauma population. The aim of this study was to evaluate whether PMC reduced tracheostomies and percutaneous endoscopic gastrostomies (trach/PEG) and readmission rates in the geriatric trauma population. Retrospective cohort analysis of patients 65 years of age and older, admitted to a Level I trauma center surgical intensive care unit from 2013 to 2014. Patients who died within 1 day were excluded. Statistical analyses included descriptive statistics, independent-samples t test for continuous variables, χ test for categorical variables, and logistic regression analysis. A total of 202 patients were included. Palliative medicine consultation occurred in 48%. Average time from admission to PMC was 2.91 days. Thirty-day readmission rate was 19.3%. Patients with a PMC (69.1%) were less likely to undergo trach/PEG (30.9%; p < .001) but more likely if the consult was late (>72 hr posttrauma; 22.0% vs. 40.4%; p = .05). Patients without a trach/PEG were more likely to survive 1 year posttrauma (85.7% vs. 14.3%; p = .003). Thirty-day readmission rates were similar between groups. In a logistic regression analysis, PMC, age, and injury severity score demonstrated an independent association with trach/PEG (all p < .05). Early palliative consults (<72 hr posttrauma) for geriatric trauma patients may reduce tracheostomy and percutaneous endoscopic gastrostomy procedures and hospital stays.

Mood-altering drugs in the trauma population: hidden dangers, deadly combinations.

Depression is on the rise, and as a result, there is an increased use of psychotropic medications. Also, nonreversible anticoagulants have entered the market and are increasing in use. In combination, these developments have created new risk factors for trauma patients. Our study examined the occurrence of trauma patients who present with a history of psychotropic medication, and we also sought to determine the rate of psychotropic medication and blood thinner use in the older adults. Because these drugs may play a role in causing injury and worsening outcomes, prescribers need to be aware of the patients' medication history and the potential risks.

Pinch-off syndrome: case report and collective review of the literature.

Pinch-off syndrome (POS) occurs when a long-term central venous catheter is compressed between the clavicle and the first rib. The compression can cause transient obstruction of the catheter and may result in a tear or even complete transsection and embolization of the catheter. POS may be preceded by a finding of "pinch-off sign" on chest X-ray (CXR) films in which the catheter is indented as it passes beneath the clavicle. We performed a collective review of the 109 cases of POS in the medical literature and report 3 new cases. On average, POS occurs 5.3 months after the insertion of the catheter but has ranged from immediately after insertion to 60 months later. If the subclavian vein is used for access, then an upright CXR should be obtained after the procedure and periodically thereafter to rule-out POS. Treatment of POS is removal of the catheter. If the tip of the catheter has embolized, it can usually be retrieved percutaneously with a transvenous snare. POS can be prevented by using the internal jugular vein for access rather than the subclavian vein.