Trauma Surgery & Acute Care Open最新文献

Background: Prior studies have associated nighttime transfer of patients from the intensive care unit (ICU) with increased morbidity. This study sought to examine this relationship in traumatically injured patients, as this has not been previously performed.

Methods: A retrospective review of traumatically injured patients admitted to a Level I Trauma Center's ICU from January 2021 to September 2022 was performed. "Day shift" (DS) was defined as 07:00 to 19:00 and "night shift" (NS) as 19:01 to 06:59. The time of transfer completion was based on the time of the patient arrival at the destination unit. The univariate analysis compared patients with completed transfers during DS and NS. Multivariate logistic regression was performed to predict readmission to the ICU.

Results: A total of 1,800 patients were included in the analysis, with 608 patients that had completed transfers during NS, and 1,192 during DS. Both groups were similar, with no significant differences in age, sex, Injury Severity Score (ISS), mechanism of injury, or median total comorbidities. The NS group had a longer median time to transfer completion (10.1 (IQR 5.5-13.6) hours vs 5.1 (IQR 2.9-8.4) hours; p<0.001). A significantly higher proportion of the NS group had a readmission to the ICU (60 (10.0%) vs 86 (7.0%); p=0.03) or a major complication (72 (11.9%) vs 107 (9.0%); p=0.048). When controlling for age, comorbidities, ISS, time to bed assignment and to transfer completed, and ICU length of stay, transfer completion during NS was associated with 1.56 times higher odds of having an ICU readmission (OR 1.56 (95% CI 1.05, 2.33); p=0.03).

Conclusions: Trauma patients transferred from the ICU during NS experienced longer delays, readmission to the ICU, and major complications significantly more often. With increasing hospital bed shortages, patient transfers must be analyzed to minimize worsened outcomes, especially in traumatically injured patients.

Level of evidence: Level III, therapeutic/care management.

Background: Retrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.

Methods: In this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.

Results: A woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient's hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.

Conclusions: Our findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries.

Clinical documentation is an essential part of medical practice. Medical records serve as a durable testament of care provided and are fundamental to communication among providers. Medical records provide justification and support for healthcare coding and billing for providers and hospitals and also provide evidence in regulatory and legal proceedings. Here, the authors emphasize the importance of clinical documentation in support of both professional and hospital billing and address two areas of recent regulatory changes: Operative coding for hernia operation and professional coding for critical care. The important role of provider documentation in supporting organizational revenue and quality is also discussed.