BACKGROUND:Advanced practice providers (APPs) are integral members of trauma teams who demonstrate improved quality of care, patient throughput, and decreased costs. Trauma standards state that APPs who have a defined role caring for trauma patients must be adequately prepared to do so. However, specific educational requirements and competencies remain poorly defined. The most recent national surveys on trauma APPs were conducted in 2013 and 2014, leaving a significant gap in the literature. OBJECTIVE:To describe the current demographic composition of APPs within trauma centers, their education, certification, roles on the team, and provider-to-patient ratios. METHODS:This quantitative, descriptive, cross-sectional study was conducted between August 4 and September 28, 2025. A 26-item online survey was distributed via email to members of the American Trauma Society, using convenience and snowball sampling. RESULTS:Survey links were accessed 90 times; 53 participants initiated the survey, and 43 completed it. Of those who initiated the survey, 81.1% (43/53) completed it. Respondents represented 15 states, with Pennsylvania accounting for the largest proportion at 54.7% (29/53). Approximately 13.2% (7/53) of the APPs had doctoral degrees. Increased variability in nurse practitioner educational preparations was noted. Experience caring for traumatically injured patients averaged 8.6 (SD = 7.72) years. Nearly 66 percent (65.9%, 29/44) of the participants had leadership responsibility, 36.4% (16/44) performed research, and 29.5% (13/44) authored publications. CONCLUSIONS:Trauma APPs represent diverse educational backgrounds, certifications, and responsibilities, with provider-to-patient ratios varying widely across settings. Educational requirements remain minimally defined and are primarily limited to advanced trauma life support certification. Standardized trauma-specific competencies are needed to ensure consistent high-quality care.
BACKGROUND:Nurse burnout during COVID-19 has been well studied; however, limited research exists on the impact of hospital administrators' interventions on trauma nurses' perceptions of burnout and value during staffing crises. OBJECTIVE:To examine contributors to burnout and explore administrative interventions affecting trauma nurses' perceived value during COVID-19. METHODS:This exploratory, sequential mixed-methods study was conducted in 2 phases at a Level II trauma center in the western United States from January 2022 to January 2024. In phase 1, qualitative data from 13 semi-structured interviews with trauma nurses and administrators informed development of a cross-sectional survey. In phase 2, the resulting 50-item survey was distributed at the trauma center, through the Society of Trauma Nurses list serv, and at the 2023 conference. RESULTS:Of 204 individuals who initiated the survey, 126 (62%) completed it (local: 45/69, 65%; national: 81/135, 60%). A response rate could not be calculated because of the multimodal distribution method. Exhaustion from an increased workload was the most reported burnout factor ( n = 115/123, 93%). Distress from crisis standards of care ranked second ( n = 112/124, 90%). Nurses felt most valued from financial incentives ( n = 92/123, 75%) and a responsive administration ( n = 79/123, 64%). Nurses felt least valued from "Healthcare Heroes" campaigns ( n = 75/124, 60%). Nurses satisfied with administrative support had lower odds of reporting burnout from administrative delays (OR, 0.49; 95% CI, 0.31-0.85; p < .01). CONCLUSIONS:Administrative approaches that reduce workload, prioritize responsiveness, and emphasize higher wages may improve nurse perceptions of value and mitigate burnout during staffing crises, whereas symbolic gestures such as "Healthcare Heroes" should be avoided.
BACKGROUND:Falls are a leading cause of injury-related morbidity and mortality among older adults and account for substantial Emergency Medical Services (EMS) utilization. Despite their frequency, few studies have examined the geographic distribution of fall-related EMS responses, and few trauma centers have leveraged EMS-derived data to identify high-risk communities. OBJECTIVE:To examine fall-related EMS calls among adults aged 65 years and older, describe patient and incident characteristics, and use Geographic Information System (GIS) mapping to identify areas with high event-based utilization rate of dispatched falls to support injury prevention efforts. METHODS:This retrospective descriptive study examined 5 years of EMS call records from July 1, 2019, to June 30, 2024. Cases were included when the primary dispatch complaint indicated a fall, and the patient was aged 65 years or older. Duplicate records were removed using deterministic matching. County-level event-based utilization rates were calculated using population estimates. GIS mapping was used to visualize county-level rates and ZIP code-level counts of fall-related EMS activity. RESULTS:A total of 43,920 fall-related EMS calls met inclusion criteria. County-level event-based utilization rates ranged from 2397 to 4167 per 10,000 older adults. Most events occurred in private residences (67.04%), involved advanced life support-level EMS units (85.16%), and resulted in patient transport (67.76%). The mean patient age was 81.33 years. CONCLUSIONS:Falls among older adults place a substantial burden on EMS and trauma systems. GIS-based mapping of EMS data may help inform trauma center injury prevention planning and identify communities where targeted outreach may reduce injury risk.
BACKGROUND:Timely transition from the emergency department (ED) to definitive care is critical in severely injured patients. Deploying surgical trauma intensive care nurses (ICU) as trauma response nurses (TRNs) during highest (alpha-level) trauma activations may improve care coordination and expedite transitions; however, evidence supporting this practice remains limited. OBJECTIVE:To evaluate the effect of the TRN on ED length of stay (LOS) and time to definitive care for alpha trauma activation patients. METHODS:This single-center, retrospective cohort study analyzed all alpha trauma activations involving patients aged 16 years and older admitted to a Level I trauma center in the southeastern US between July 1, 2022, and June 30, 2024. Clinical outcomes were compared between patients managed with and without a TRN during trauma bay resuscitation. RESULTS:Among 353 patients, 193 (55%) were in the TRN group and 160 (45%) in the non-TRN group. The median ED LOS was 77 minutes (IQR, 59-105.5) for the TRN group versus 81.5 minutes (IQR, 61.5-127.3) for the non-TRN group ( p = .20, r = 0.07). The median time to the operating room (OR) was 63 (IQR, 32-94.5) minutes versus 80 (IQR, 24.8-120.5) minutes ( p = .88, r = 0.03). The median time to ICU was 77 (IQR, 62.5-105) minutes with a TRN, compared to 81 (IQR, 65-129.3) minutes ( p = .21, r = 0.07). We did not observe statistically significant differences between groups. CONCLUSION:ED LOS, time to OR, and time to ICU were similar between groups, with slightly lower values in patients with TRN involvement. Further evaluation is needed to determine clinical relevance and impact on trauma protocol adherence.
BACKGROUND:While most concussion research focuses on sports or military injuries, most emergency department-diagnosed concussions result from other forms of trauma, highlighting a gap in understanding concussion prevalence among admitted trauma patients. OBJECTIVE:To assess the prevalence of concussion in admitted trauma patients using systematic screening, and to evaluate associated symptoms, screening tool performance, and cognitive deficits within this population. METHODS:A single-center, prospective cross-sectional study was conducted over 3 months (April-June 2023) at a southeastern US Level I Trauma Center that examined concussion prevalence in admitted trauma patients using systematic screening. The Standardized Assessment of Concussion (SAC) was completed within 48 hours for eligible patients, and the Cognistat evaluation was used to assess concussion-related deficits; 3 additional questions assessed amnesia. RESULTS:A total of 1077 patients were evaluated for study inclusion, with 285 meeting criteria. The age range was 14-95 years, with a mean of 46.5 (SD 18.4). Males were the largest group, accounting for 184 (64.6%). The median Injury Severity Score was 16. Using the Standardized Assessment of Concussion for concussion screening, 122 (42.8%) were diagnosed with concussions. Further testing with the Cognistat showed 54 patients (44.2%) had moderate to severe cognitive deficits. CONCLUSION:Our study showed that systematic screening of trauma patients helps identify underappreciated, subtle diagnoses, which can potentially cause long-term negative effects if not treated promptly.
BACKGROUND:Chest tube management is a high-risk, low-frequency clinical skill requiring prompt nursing assessment, troubleshooting, and escalation to prevent complications. Limited exposure may contribute to variability in nursing confidence. Simulation-based education reinforces pediatric nurses' readiness for chest tube management. OBJECTIVE:This quality improvement initiative aimed to implement and evaluate a simulation-based educational intervention to improve pediatric nurses' confidence, anxiety, and knowledge related to chest tube management. METHODS:This quality improvement initiative used a single-group pretest-post-test design with delayed follow-up, incorporating 3 assessment time points: preintervention, immediately postintervention, and 2-month follow-up. The study was conducted between July and December 2025 at a Level I pediatric Midwestern US trauma center. Registered nurses participated in a 1-hour simulation with 3 stations focused on chest tube assessment, troubleshooting, and escalation. Pediatric surgery faculty and residents served as facilitators. Surveys assessing confidence, anxiety, and knowledge were administered at all time points. Mean differences, 95% confidence intervals, and effect sizes were calculated. RESULTS:Sixty-five nurses completed preintervention and postintervention surveys; 22 completed follow-up. Mean confidence increased from 3.9 to 4.8 (mean difference 0.9; 95% CI, 0.7-1.1; Cohen d = 1.12), anxiety decreased from 2.9 to 1.9 (mean difference -1.0; 95% CI, -1.3 to -0.7; Cohen d = -0.83), and knowledge increased from 5.60/7 to 6.65/7 (mean difference 1.05; 95% CI, 0.84-1.26; Cohen d = 1.99). Improvements were observed at follow-up. CONCLUSIONS:Simulation-based education was associated with improved nurse confidence, reduced anxiety, and increased knowledge related to pediatric chest tube management.
BACKGROUND:Uncontrolled bleeding after trauma is the main preventable cause of death and often requires rapid fluid resuscitation and massive blood transfusion. Accurately predicting the need for massive transfusion is critical to improving outcomes in patients with trauma. OBJECTIVE:To systematically assess and quantify the effectiveness of machine learning (ML) models in predicting massive transfusion needs in patients with trauma. METHODS:A comprehensive search of 7 databases was conducted from inception to March 2024. Studies were screened based on prespecified inclusion criteria. Data were extracted using a standardized checklist and evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Pooled performance metrics were calculated using a random-effects model, including area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and diagnostic odds ratio (DOR). Heterogeneity was assessed using Cochran Q and I2 statistics, and potential sources of variation were identified through meta-regression. RESULTS:After screening, 12 studies were included in the final analysis. The pooled AUC for ML models predicting transfusion needs was 0.89, with sensitivity and specificity values of 0.83[95% CI: 0.84-0.83] and 0.84(95% CI: 0.83-0.85), respectively. Despite overall strong predictive performance, the included models showed considerable methodological heterogeneity, particularly in feature selection, handling of missing data, and model validation. CONCLUSIONS AND IMPLICATIONS:Although the ML models assessed across the included studies demonstrated robust performance in predicting massive transfusion needs in patients with trauma, the studies showed methodological inconsistencies. To ensure reliable clinical implementation, future research should focus on developing standardized protocols for model development and validation. REGISTRATION:PROSPERO #CRD42024565253.
BACKGROUND:Injury leads to long-term physical and mental health challenges, yet inpatient screening for post-traumatic stress disorder and depression remains inconsistent, and postdischarge mental health is poorly understood, particularly in less resourced trauma centers where emerging symptoms may go unrecognized. OBJECTIVE:To evaluate the feasibility of using the electronic medical record to identify postdischarge mental health screening documentation in adult trauma patients within 6 months after discharge. METHODS:This retrospective descriptive feasibility study was conducted at a midwestern US regional Level II trauma center serving a predominantly rural catchment area. Adult trauma patients admitted between January 1 and December 31, 2024, were eligible for inclusion. A stratified sampling strategy was used, selecting up to 4 records per month, with follow-up data collected for 6 months postdischarge. RESULTS:The final sample included 48 patients with a median age of 67 (IQR: 18) years, predominantly male (n = 35, 73%), and White (n = 40, 83%). A total of 7 patients (15%) screened positive for post-traumatic stress disorder risk, depression risk, or both during inpatient admission. Trauma-related follow-up was documented in the electronic medical record for 37 patients (77%), with a median of 15 days (IQR: 16) to first follow-up appointment and a median of 2 provider contacts (IQR: 1) within 6 months of discharge. Despite this follow-up, only 1 of 37 patients (3%) with documented follow-up had a documented mental health screening during the postdischarge period. CONCLUSION:This feasibility study found that the electronic medical record alone was insufficient to capture postdischarge mental health screening documentation, with only 1 screening identified across 37 patients with documented follow-up, highlighting a critical gap in care continuity that warrants further investigation.
BACKGROUND:Alcohol misuse among teenagers poses serious public health risks. The screening, brief intervention, and referral to treatment approach aims to prevent, discourage, and treat substance use issues. Despite recommendations to screen all trauma admissions of patients older than 12 years, implementation at trauma centers is often inconsistent and inefficient. OBJECTIVE:This study aims to assess the impact of integrating targeted information technology (IT) solutions into electronic health record (EHR) systems on improving the consistency and effectiveness of alcohol misuse screening in admitted patients over the age of 12 years. METHODS:This study is a single-center, pre-post intervention quality improvement project carried out at an urban academic Level I pediatric trauma center in the Southeastern United States. Data were retrospectively gathered from April 2022 to September 2025. The intervention involved surveying peer centers, mandating EHR-based alcohol screening, integrating blood ethanol testing, automating alerts for social workers on positive screens, and providing staff education with real-time feedback. RESULTS:A total of 1126 pediatric injured patients met the inclusion criteria. The preintervention group consisted of 600 patients spanning from April 2022 to February 2024, while the postintervention group comprised 526 patients from March 2024 to September 2025. The rate of alcohol misuse screenings increased from 65.67% preintervention to 89.54% postintervention. CONCLUSION:Adopting a multicomponent interventional strategy, along with integrated order selections for specific admission sets, can establish a consistent workflow that sustained compliance over a 19-month period. However, extended follow-up across various institutions will be necessary to verify its long-term sustainability.
BACKGROUND:Delirium is common among hospitalized trauma and acute care surgery patients and may be under-recognized on surgical wards. Understanding which patient factors are associated with earlier versus later documented delirium diagnosis may inform targeted surveillance and prompt recognition. OBJECTIVE:To identify factors associated with the timing of documented delirium diagnosis among adult trauma and acute care surgery patients admitted to a surgical ward. METHODS:This single-center, retrospective cohort study included adults admitted to a trauma and acute care surgery ward (January 2020-December 2024) who developed delirium during hospitalization. The primary outcome was the hospital day of first documented delirium diagnosis. Univariate comparisons used nonparametric testing for dichotomous predictors. Multivariable linear regression evaluated independent associations with delirium diagnosis timing. Results should be interpreted with caution due to non-normality in regression residuals. RESULTS:A total of 182 patients were included (mean age 83.0 years). The mean day of documented delirium diagnosis was 4.7 days. Older age was associated with earlier documented delirium diagnosis (r = -0.31, p < .0001). In multivariable regression, age remained an independent predictor of documented delirium diagnosis timing (β = -0.085, p = .0004; R 2 = 0.114), while injury severity and sex were not independent predictors. CONCLUSIONS:Age was an independent predictor of earlier documented delirium diagnosis among trauma and acute care surgery ward patients. These findings suggest that early and consistent delirium monitoring in older patients and heightened vigilance may help avoid delayed recognition. Further research is needed to determine whether targeted surveillance strategies improve outcomes.
BACKGROUND:Assessment of triage procedures is crucial for improving patient care. Most programs evaluate under- and over-triage using the ISS-based Cribari Matrix Method (CMM), but tools such as the critical-intervention-based Need for Trauma Intervention (NFTI) and its time-critical modified version (mNFTI) focus on identifying patients who need immediate resources. The mNFTI has seen limited empirical inquiry in assessing triage procedures. OBJECTIVE:To assess accuracy and agreement rates between mNFTI and CMM. METHODS:This multicenter, retrospective cohort study compared triage classifications in trauma patients using 2019 trauma registry data from trauma centers across 5 trauma systems in Ohio, United States. Patients meeting Ohio/National Trauma Data Standards for traumatic injury were included. Triage classifications were assigned by mNFTI and CMM and compared across all patients and injury subgroups using statistical tests (McNemar, symmetry, Cohen Kappa) to determine agreement and differences between the 2 methods. RESULTS:The final analysis included 27,637 patients. Patient count tables show classification differences for all patients and injury subgroups. The statistical tests reveal differences in retrospective triage assessment by the mNFTI and CMM. Among 27,637 patients, mNFTI and CMM classifications differed significantly at both the population and subgroup levels ( p < .05 for all comparisons). The agreement between methods was weak to moderate. CONCLUSIONS:This study demonstrates that mNFTI produces significantly different trauma triage classifications compared with the Cribari Matrix Method, with moderate agreement between the 2. These differences suggest that mNFTI may better identify patients who require immediate trauma intervention and could help address undertriage in trauma systems. Further research is warranted to validate mNFTI as a stand-alone quality metric for trauma triage.
BACKGROUND/RATIONALE:Rural areas face a disproportionate trauma burden, with patients injured outside urban centers experiencing a 14% higher mortality rate, primarily because of long distances, transport delays, and limited specialist availability that hinder timely, high-quality care. Studies show that roughly one-quarter to nearly one-half of interfacility transfers from rural hospitals qualify as secondary overtriage. OBJECTIVES:This concise review aims to evaluate the impact of telemedicine on secondary overtriage and its associated patient outcomes, barriers to telemedicine implementation, and subsequent financial implications in rural trauma care settings. METHODS:Our review searched 5 databases, screening articles published before July 7, 2025. Studies focusing on evaluating the effects of telemedicine in rural adult trauma settings were included. RESULTS:A total of 7 articles met the inclusion criteria. The implementation of teletrauma in rural hospitals resulted in decreased interfacility transfer rates to higher-level facilities, with up to 89% of patients being treated locally without transfer and without an associated increase in mortality or hospital length of stay (2.1 days vs. 2.2 days) between transferred and nontransferred patients. Barriers to telemedicine implementation included licensure, technological reliability, and initiation costs. In addition, preliminary evidence from 2 single-site studies suggests that telemedicine may reduce both hospital expenditures for the trauma center ($7,632,624-$1,126,683, p < .001) and interfacility transfer costs ($47,233 vs. $34,017, p < .0001), although further multisite research is needed to confirm these findings. CONCLUSION:Despite existing barriers, telemedicine in rural trauma presents the potential to decrease unnecessary transfers without adversely affecting clinical outcomes, with early evidence suggesting meaningful financial benefits for rural trauma facilities.
BACKGROUND:Unidentified patients pose challenges in emergency care due to missing clinical history and identification, impacting patient safety and decision-making. Despite known risks, little is understood about this group in middle-income countries. OBJECTIVE:To describe the epidemiological profile and the clinical, structural, and social challenges that influence the care of unidentified patients in a public teaching hospital. METHODS:This retrospective cohort study was conducted from January 2019 to December 2022 in the emergency department (ED) of a public teaching hospital in Belo Horizonte, Brazil. Data from unidentified patients were extracted from electronic medical records, including demographics, admission reasons, risk classification, clinical management, outcomes, and hospital length of stay. Multivariate logistic regression was used to identify factors associated with adverse outcomes, adjusting for clinical and sociodemographic variables. RESULTS:Among 2,425 unidentified ED admissions, 332 cases were sampled using a finite population correction formula. Of these, 81.6% were male; median age was 32 years (interquartile range 26-43). Main admission causes were physical assault (39.8%), falls (20.5%), and road traffic collisions (10.8%); 69.9% were triaged as very urgent. Only 29.2% were identified before discharge; time as unidentified ranged from 0 to 411 days (median 1 day). Remaining unidentified beyond one day was strongly associated with adverse outcomes (odds ratio 8.56; 95% confidence interval 5.0-14.6; p < .001). CONCLUSION:Delayed identification was associated with adverse outcomes, but causality cannot be inferred. Early identification initiatives should be combined with broader strategies to address underlying risks and ensure continuity of care.
BACKGROUND:The American College of Surgeons mandates eight trauma activation criteria for full trauma activations, yet many centers exceed this number to minimize undertriage. The association between trauma activation criteria and triage accuracy and resource use is poorly studied. OBJECTIVE:To assess the relationship between the number of criteria for full trauma activation and rates of activation, undertriage, overtriage, mortality, and hospital length of stay. METHODS:This multicenter retrospective cohort study analyzed survey and trauma registry data from 36 trauma centers across 16 U.S. states and the District of Columbia. Centers reported their activation criteria used for full trauma activation from 2017 to 2019, and outcomes were evaluated using multivariable negative binomial regression and weighted linear regression. RESULTS:Among 218,832 patients, the number of trauma activation criteria per center ranged from 8 to 28, with a mean of 16.75 and an SD of 4.47. The number of criteria was not significantly associated with the proportion of full trauma activation (adjusted incidence rate ratio [aIRR] = 1.02 [95% CI 0.996, 1.05], p = .097), undertriage (aIRR = 0.98 [95% CI 0.96, 1.003], p = .081), mortality (aIRR = 1.00 [95% CI 0.99, 1.01]; p = .952), or length of stay ( b = -0.001 [95% CI -0.059, 0.058], p = .985). However, more criteria were significantly associated with greater overtriage (aIRR = 1.02 [95% CI 1.003, 1.03], p = .010). CONCLUSION:Increasing the number of trauma activation criteria was not linked to improved undertriage or clinical outcomes, but was associated with higher overtriage, suggesting a greater burden on trauma resources without clinical benefit.
INTRODUCTION:Patients with reduced mobility face elevated risks of complications, including pressure ulcers and functional decline. Automated beds and robotic mobility systems are emerging tools to support early mobilization and reduce caregiver burden, but their overall impact remains unclear. OBJECTIVE:To systematically review the evidence on the effectiveness of automated bed systems and robotic mobility technologies compared to conventional care in improving clinical and functional outcomes in immobile adult patients. METHODS:We searched PubMed, Scopus, Web of Science, CINAHL, and Google Scholar from inception to September 29, 2025. Eligible studies included adults (≥18 years) with neurological conditions or immobility receiving automated or robotic mobilization interventions compared with standard care. Outcomes of interest were motor function, quality of life, hemodynamic stability, caregiver workload, and cost-effectiveness. Two reviewers independently screened studies and extracted data. Risk of bias was assessed with validated tools. A narrative synthesis was performed due to heterogeneity in study design and outcomes. RESULTS:Nine studies involving 380 patients met the inclusion criteria. Robotic and automated systems were associated with improved functional outcomes, reduced incidence of pressure injuries, and enhanced caregiver efficiency. Heterogeneity in study design and intervention protocols precluded meta-analysis. CONCLUSION:Automated and robotic mobility systems may support early mobilization and improve care outcomes in immobile patients. Further high-quality studies are needed to confirm their long-term clinical and economic benefits.
BACKGROUND:In adult patients with head trauma, the location and characteristics of the visible head injury have been associated with adverse outcomes, such as traumatic intracranial hemorrhage and cervical spine injuries. OBJECTIVE:This study aimed to evaluate the reliability of head injury location and characteristics between Emergency Medical Dispatcher (EMD) and Emergency Department (ED) assessments in patients contacting an EMD for head injuries. A secondary objective was to assess how this reliability varied depending on the individual contacting the EMD. METHODS:This study was a planned sub-analysis of a multicenter, prospective, observational cohort study conducted over three 3 days in March 2023 in France (EPI-TC study). Main outcome was visible head injury location and characteristics. Standardized data collection occurred during the EMD call and upon ED admission. Interobserver reliability between EMD and ED assessments was measured using kappa coefficient. RESULTS:Overall, 241 patients from 20 participating EMD and 20 EDs were included in this sub-analysis and most of them (79.3%) were community-dwelling patients. The EMD was most frequently contacted by unrelated witnesses (27.8%). Head injury location and characteristic were reliable between EMD and ED, with kappa coefficients of 0.76 (95% CI 0.73-0.79) and 0.76 (95% CI 0.72-0.81), respectively. However, this reliability was low when EMD was called by the patient himself (kappa coefficient 0.59 (95% CI 0.50-0.69) and 0.52 (95% CI 0.38-0.66) respectively). CONCLUSIONS:In cases of head injuries, phone-based assessments by EMD regarding head injury location and characteristics are reliable in adult patients when reported by a witness. However, caution is recommended if the patients call the EMD themselves. In these cases, alternative evaluation methods could be considered, such as onsite assessment by a health care professional or telemedicine-based photographic transmission.
