THC IS MORE PREDICTIVE OF A GREATER INJURY SEVERITY SCORE THAN ALCOHOL FOR TRAUMA PATIENTS OVER 30
General & Internal Medicine
Muakkassa F F; Marley R; Billue K; Yetmar Z; Salvator A
Critical Care Medicine
2014
2014-12
Journal Article
n/a
Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan
benefit; brain-injury; follow-up; intracranial injury; management; moderate; patients; serial computed-tomography; Surgery; utility
BACKGROUND: Our goal was to determine the need for a repeat head CT scan when the initial CT was negative. STUDY DESIGN: Data were collected from January 1, 2002 to December 31, 2008. There were 281 patients admitted to the trauma center with an initial negative head CT, who had a repeat CT during the same hospitalization. Repeat CTs were categorized into negative/negative (NNG) and negative/positive (NPG) groups. RESULTS: There were 281 patients who underwent a repeat head CT for changes in neurologic status, persistent symptoms, follow-up, decreased mental status, or suspected bleed. Of these, 241 patients remained negative (NNG) and new abnormal findings were noted in 40 patients (NPG). There were no differences in sex (NNG, 63% males vs NPG, 75% females; p = 0.14) or average age (NNG, 51.6 +/- 22.5 years vs NPG, 45.2 +/- 24.6 years; p = 0.07). There was no difference in positive toxicology (NNG, 29% vs NPG, 30%; p = 0.94) or mechanism of injury (NNG, 51% motor vehicle crash [MVC] vs NPG, 62% MVC; p = 0.18). There was a significant difference in Injury Severity Score (ISS) (NNG, 10.7 +/- 8.1 vs NPG, 17.9 +/- 11.0; p = 0.0002) and initial Glasgow Coma Scale (GCS) (NNG, 12.7 +/- 3.5 vs NPG, 10.9 +/- 4.2; p = 0.006). Patients with an ISS > 15 and who were intubated were associated with an increased odds of having a positive repeat CT scan (odds ratio [OR] 2.6; 95% CI 1.2, 5.5 and OR 3.5; 95% CI, 1.7, 7.3, respectively). CONCLUSIONS: Patients with a high ISS score and/or those who are intubated have significantly higher odds of having a positive repeat head CT when repeated for follow-up or when clinically warranted. (J Am Coll Surg 2012;214:965-972. (C) 2012 by the American College of Surgeons)
Muakkassa F F; Marley R A; Paranjape C; Horattas E; Salvator A; Muakkassa K
Journal of the American College of Surgeons
2012
2012-06
Journal Article
<a href="http://doi.org/10.1016/j.jamcollsurg.2012.02.004" target="_blank" rel="noreferrer noopener">10.1016/j.jamcollsurg.2012.02.004</a>
Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients
after-discharge; alcohol; anemia; association; brain-injury; Function; injury severity score; intensive-care-unit; Length of Stay; life; outcomes; Patient Outcome Assessment; Recovery of; Rehabilitation; Rehabilitation; Sport Sciences; survival
Objective: The purpose of this study was to determine whether prolonged hospital length of stay (HLOS) and rehabilitation facility length of stay (RLOS) lead to poor functional outcomes, defined as a Functional Independence Measure (FIM) score of less than 76 (LFIM) at rehabilitation facility (RF) discharge. Design: This study analyzed retrospective data collected between 2002 and 2009 on 326 patients in a trauma center and affiliated RF. Factors predicting LFIM at RF discharge were determined using multivariate logistic regression, chi(2) tests, and t tests. Results: Significant multivariate predictors of LFIM included age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.07; P < 0.0001), spinal cord injury (OR, 7.22; 95% CI, 2.73-19.02; P = 0.000), female sex (OR, 2.34; 95% CI, 1.17-4.65; P = 0.01), and RF admission FIM (OR, 0.93; 95% CI, 0.91Y0.95; P < 0.001). An increased risk of LFIM (OR, 2.21; 95% CI, 1.41Y3.45; P = 0.001) was observed with an increased ratio of HLOS/RLOS after adjusting for injury severity score. Conclusion: An increased ratio of HLOS/RLOS increases the risk of LFIM more than 2-fold after adjusting for injury severity score, spinal cord injury, and FIM upon RF admission. Delays in transfer to an RF negatively affect patient functional outcomes. Studies to identify factors affecting delays in transfer from hospitals to RF should be conducted.
Muakkassa F F; Marley R A; Billue K L; Marley M; Horattas S; Yetmar Z; Salvator A; Hayek A
American Journal of Physical Medicine & Rehabilitation
2016
2016-08
Journal Article
<a href="http://doi.org/10.1097/phm.0000000000000453" target="_blank" rel="noreferrer noopener">10.1097/phm.0000000000000453</a>