UK Albert B. Chandler Hospital / Kentucky Children s Hospital TRAUMA PROGRAM Annual Report 2008

Transcription

1 UK Albert B. Chandler Hospital / Kentucky Children s Hospital TRAUMA PROGRAM Annual Report 2008

2 Trauma Program Trauma remains the leading cause of morbidity and mortality for Americans younger than 44 years of age. Organized trauma systems with specialized trauma centers devoted to the evaluation and treatment of injured patients are effective in reducing the rates of disability and death associated with injury. The UK Albert B. Chandler Hospital Trauma Program is a Level 1 trauma center verified by the American College of Surgeons. We are one of only two Level 1 centers serving the needs of Kentuckians, and we are the only center providing tertiary care for central and southeastern Kentucky. The UK Chandler Hospital Trauma Center is committed to providing timely, high-quality, cost-effective care for patients with complex, multisystem trauma or single-system trauma requiring specialized surgical services. The program s 2008 Annual Report is designed to provide you with a brief synopsis of program activity relative to volume and patient acuity. The reporting period is July 1, 2007, through June 30, Statistics are aggregated and reported based on fiscal-year discharges. We continue to include all injury-related admissions to UK Chandler Hospital and Kentucky Children s Hospital to reflect a comprehensive programmatic view of our experience as a Level 1 trauma center. This fiscal analysis includes information regarding patient demographics, regional referral distribution and patterns, volume trends, injury severity, and overall outcomes. Our protocol manual, clinical guidelines and additional information are available upon request. The faculty and staff of the Trauma Program extend a note of appreciation to all who have supported our endeavors during the preceding fiscal year. Special thanks go to research coordinators Candice Travers, Joey Oakes-Walden, Sharon Williams and Trish Cooper for their tremendous efforts in report preparation, data retrieval and aggregation, and their attention to detail on a daily basis. Sincerely, Paul A. Kearney, MD, FACS Chief, Professor, Department of Surgery University of Kentucky College of Medicine Paul A. Kearney, MD, FACS

3 Injury Severity Score (ISS) Brief Intervention The Injury Severity Score (ISS) reflects an anatomic scoring of injury severity and is generally recognized as a tool for retrospective application only. It is calculated by assigning a severity score defined by the Abbreviated Injury Score (AIS) dictionary to any or all of the six body regions: head/neck, thorax, abdomen, extremity, external and face. The scores range from 1 (minor) to 5 (critical survival uncertain). A score of 6 may be assigned to a region that has an injury considered not survivable as defined by the AIS dictionary. After all injuries Number of Patients Number of Patients 2,000 1,600 1, Injury Severity Score Distribution 2008 Injury Severity Score Distribution 2008 (2,829 Total Patients) (62.4%) (24.9%) (10.9%) ISS Scores are identified, scores are categorized into body regions. The three top regions scores are squared and added together to calculate ISS, which ranges from 1 to 75. An ISS score of 75 can be obtained any time a single body region is assigned an AIS of 6. An ISS score of 15 or greater is the nationally accepted criterion for triage of the trauma patient to a Level I center, as these patients have at least a 10 percent chance of dying from a single severe injury or multiple severe injuries. 40 N/A (1.4%) Alcohol use is a significant factor that often contributes to traumatic injuries. Approximately 50 percent of trauma patients have positive blood-alcohol concentrations (BAC). To help correct this problem, trauma centers need protocols in place to identify and help patients who end up in the ED due to alcohol use. The University of Kentucky Trauma Program has a licensed counselor who provides brief intervention for those patients. Brief intervention is a three-step process: Step 1: The patient arrives at the ED and is screened for alcohol use. During the screening, the counselor determines the severity of the patient s use and the likelihood of dependency. Step 2: The intervention is conducted. The counselor provides the patient with feedback from the BAC levels and methods to reduce and/or stop drinking. The intervention capitalizes on the fact that alcohol plays a major role in sustaining injury and may motivate the patient to change behavior. Step 3: The patient is asked to follow up. According to the patient s needs, he or she is referred to the most appropriate level of care and provided with options for additional services. Brief alcohol intervention has been proven to reduce trauma recidivism, drinking and driving, and health care costs. The brief intervention program at has demonstrated great success.

4 Pediatric Trauma Services Kentucky Children s Hospital is a Pediatric Level I Trauma Center verified by the American College of Surgeons. Our pediatric trauma team is equipped to treat ill and injured children ranging in age from neonates to 14 years old. The team is specially trained in pediatric surgical techniques and procedures to meet the unique challenges faced when treating children. The Makenna David Pediatric Emergency Center is a part of Kentucky Children s Hospital and is the only 24-hour pediatric emergency and trauma care center in eastern Kentucky. Board-certified emergency medicine physicians and pediatric nurses take care of infants and children in a child-friendly area that has a separate waiting room and private treatment rooms with flat screen TVs and video games. Kentucky Children s Hospital is one of only two hospitals in the state with a dedicated Pediatric Intensive Care Unit (PICU). The PICU provides care for the sickest pediatric patients. PICU patient care is overseen by a pediatric intensivist, a physician who specializes in the treatment of critically ill and injured children. Our PICU nurses have received advanced training and work closely with the physicians to ensure the patients and their families get the best possible care. Emergency/Trauma Services offers a specially trained critical care neonatal/pediatric transport team. They respond to smaller rural hospitals throughout central and eastern Kentucky to transfer neonatal and pediatric patients to our tertiary care center here at UK. If a newborn or child requires more immediate transport, the neonate/pediatric transport team will respond by helicopter to transport the patient to UK. UK also offers many subspecialists dedicated to pediatric care. Along with the pediatric surgeons and pediatric emergency medicine physicians, we staff pediatric neurosurgeons, orthopaedic surgeons, anesthesiologists and radiologists who can be consulted to aid in the diagnosis and treatment of children. and the Kentucky Children s Hospital are dedicated and committed to the care of our patients. We are working together to give ill and injured patients of all ages the best care available through evidence-based medicine, research and education. Child Passenger Safety Program Led by Kentucky Children s Hospital, Safe Kids Fayette County has implemented a comprehensive Child Passenger Safety Program that serves Fayette and other counties in Central Kentucky. Although it began with only a handful of trained Child Passenger Safety Technicians in 1998, the program is now locally recognized for child passenger safety training and resources. The CPS Team includes nationally certified technicians and instructors from a variety of community partners, including those trained to serve children with special health care needs. In an effort to eliminate the leading cause of preventable injury to children, the Safe Kids Fayette County Child Passenger Safety Team uses a multifaceted approach to provide families and caregivers the tools necessary to safely transport children. The team has assisted the local fire department in providing child safety seat fitting stations by training all new firefighter recruits for the past five years. They also conduct a monthly car seat fitting station and several community car seat checks throughout the year. Other programs include child safety seat workshops, informative booths, and interactive displays at health and resource fairs in the community. The Child Safety Seat Assistance Program is the only one of its kind in the area that assists families unable to afford a new child safety seat. Percentage 100 Percentage of Children Restrained during Accidents Fiscal Year Year

5 Trauma Education and Research The UK Trauma Program maintains active research in both clinical and basic science. The Trauma Research Program conducts laboratory research focusing on the effects of transfusion on immunity. Clinical research programs include human drug trials investigating novel sepsis, antimicrobial agents and new surgical devices. A long-term human research program aimed at identifying biomechanical risk factors for ATV crashes is also under way. Once this research is collected, the information obtained is disseminated through various educational venues and crosses many areas: prehospital, nursing, physicians, injury prevention, chemical dependency and brief interventions. At the medical center, educational opportunities resulting in certification include Advanced Trauma Life Support (ATLS), Trauma Nurse Core Course (TNCC) and the Emergency Nurse Pediatric Course (ENPC). Our clinicians and faculty involved in trauma care also frequently visit other facilities to educate others in a variety of trauma topics.

6 Trauma Data Top Referring Hospitals St. Joseph-London 75 Hazard ARH 74 St. Claire Medical Center 72 Clark Regional Medical Center 71 Ephraim McDowell Regional Medical Center 59 Lake Cumberland Regional Hospital 54 Pattie A. Clay Hospital 54 Meadowview Regional Medical Center 50 Kentucky River Medical Center 47 Knox County Hospital 46 Others Combined 975 Total Outcome Distribution Outcome Distribution 93.5% 6.5% Alive 94% (2,812) Deceased 6% (172) Alive (2,646) Deceased (183) Trauma Type Distribution Trauma Type Distribution 8.9% Blunt 91.5% (2,632) Penetrating 8.5% (245) Blunt (2,578) 91.1% Penetrating (251) Top Causes of Injury Fall 601 Discharge Distribution Trauma Discharge Distribution Motor vehicle crash restrained 563 Motor vehicle crash unrestrained 531 ATV 197 2,500 2, Gunshot/shotgun wound 138 Motorcycle crash helmeted 113 Motorcycle crash non-helmeted 110 Stabbing 86 Number 1,500 1, Thermal Burn 84 Assault 79 Others Combined Home (79%) Rehab (10.3%) Morgue (6.5%) Skilled nursing (1.6%) LTC Other acute care hospital Discharge Location Other Psychiatric facility Prison Foster care

7 Patients Referred, by County of Injury Boone Campbell Kenton Gallatin Bracken Carroll Grant Trimble Mason Lewis Greenup Harrison Henry Fleming Oldham Nicholas Carter Owen Boyd Scott Jefferson Shelby Franklin Bourbon Bath Rowan Elliott Lawrence Woodford Montgomery Spencer Fayette Bullitt Anderson Clark Menifee Morgan Meade Johnson Jessamine Powell Martin Hancock Mercer Nelson Wolfe Henderson Breckenridge Washington Madison Estill Magoffin Union Daviess Hardin Boyle Garrard Lee Marion Breathitt Floyd Pike Webster Larue McLean Lincoln Jackson Owsley Ohio Grayson Knott Rockcastle Taylor Perry Crittendon Hopkins Hart Casey Butler Green Livingston Muhlenberg Edmonson Clay Letcher Pulaski Laurel Leslie Caldwell Adair Ballard McCracken Lyon Warren Barren Metcalfe Russell Knox Harlan Carlisle Marshall Christian Todd Logan Cumberland Wayne Graves Trigg Simpson Allen Monroe Clinton McCreary Hickman Whitley Bell Calloway Fulton Pendleton Robertson Air Medical Transports LifeNet Helicopter Service 613 PHI 297 Air Evac Life Team 87 Medflight of East Kentucky 27 Wings Air Rescue 17 Unspecified 10 Stat Care 5 Med Flight of Ohio 4 Healthnet Aeromedical Services, 4 Huntington, WV Healthnet II 3 Others Combined 8 Top Transport Agencies LifeNet Air Medical 613 Age Distribution of Patients Age Distribution Scene vs. Interfacility Transfers Scene vs. interfacility transfers Lexington Fire Department 378 PHI 297 Madison County EMS 96 Number Number 1, % 44% Air Evac Life Team 95 Georgetown-Scott County EMS 63 Jessamine County Ambulance Service 63 Winchester-Clark County Fire Department EMS 56 Ambulance Inc. of Laurel County 50 Perry County Ambulance Authority Inc Ages Ages Interfacility transfers (1,579) Transfers direct from scene (1,250) Private Transportation 142 Others Combined 889

8 Trauma/Critical Care F a c u l t y a n d S t a ff Paul A. Kearney, MD, FACS Chief, Professor, Department of Surgery Matthew Simpson, MD Fellow, Department of Surgery Bernard R. Boulanger, MD, FRCSC, FACS Associate Chief of Staff, Section of Trauma and Critical Care Associate Professor, Department of Surgery Lisa Fryman, RN Andrew C. Bernard, MD Assistant Professor, Department of Surgery Phillip K. Chang, MD Assistant Professor, Department of Surgery Anthony J. Bottiggi, MD Assistant Professor, Department of Surgery Director of Surgical ICU VAMC Lexington, KY Brian Sonka, MD, FACS Fellow, Department of Surgery Penne S. Allison, RN, BSN, MSOM Director, Emergency/Trauma Services Trauma Nurse Coordinator/Program Manager Emergency/Trauma Services Bari Lee Mattingly, RN Pediatric Trauma Nurse Coordinator Emergency/Trauma Services David Maynard, MA, LPCC Licensed Professional Clinical Counselor Chemical Dependency Specialist Emergency/Trauma Services Jennifer Forman, RN Trauma Outreach Coordinator Emergency/Trauma Services Darcy Tekuvle, RN Patient Care Facilitator Blue Surgery Services Amie Adkisson, RN Patient Care Facilitator Blue Surgery Services To refer patients to Trauma Center, call UK MDs at or Emergency Transport Services at Division of P e d i at r i c S u r g e r y Trauma Program Off i c e S t a ff M e m b e r s Andrew R. Pulito, MD Chief, Division of Pediatric Surgery Kentucky Children s Hospital Professor and Vice Chair, Department of Surgery For information regarding additional data not shown in this report, future data inquiries/ research, the Trauma Injury Prevention Program, ATLS Certification or the annual Trauma Symposium, call the UK Trauma Program Office at the numbers listed below. Joseph Iocono, MD Director of Pediatric Trauma Kentucky Children s Hospital Division of Pediatric Surgery Assistant Professor, Department of Surgery Sean Skinner, MD Division of Pediatric Surgery Kentucky Children s Hospital Assistant Professor, Department of Surgery Patricia Cooper Trauma Research Coordinator Candice Travers Trauma Research Coordinator Joey Oakes-Walden Trauma Research Coordinator Joyce Swim Trauma Administrative Coordinator Sharon Williams Pediatric Trauma Research Coordinator