Claudia P Orlas1,2, Juan Pablo Herrera-Escobar3, Cheryl K Zogg3, José J Serna4,5, Juan J Meléndez4, Alexandra Gómez6, Diana Martínez7, Michael W Parra8, Alberto F García4,5, Fernando Rosso9, Luis Fernando Pino4, Adolfo Gonzalez4, Carlos A Ordoñez10,11,12. 1. Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA. corlasbolanos@bwh.harvard.edu. 2. Clinical Research Center, Fundación Valle del Lili, Carrera 98, #18-49, Cali, Colombia. corlasbolanos@bwh.harvard.edu. 3. Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA. 4. Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia. 5. Fundación Valle del Lili, Departamento de Cirugia de Trauma y Emergencias, Cali, Colombia. 6. Facultad de ciencias de la salud, Universidad del Valle, Cali, Colombia. 7. Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia. 8. Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA. 9. Fundación Valle del Lili, Departamento de Infectologia, Universidad Icesi, Cali, Colombia. 10. Seccion de Cirugia de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cali, Colombia. ordonezcarlosa@gmail.com. 11. Fundación Valle del Lili, Departamento de Cirugia de Trauma y Emergencias, Cali, Colombia. ordonezcarlosa@gmail.com. 12. Clinical Research Center, Fundación Valle del Lili, Carrera 98, #18-49, Cali, Colombia. ordonezcarlosa@gmail.com.
Abstract
BACKGROUND: The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma center (Pu-TC) and one private trauma center (Pri-TC). METHODS: Patients with thoracic trauma admitted from January 2012 to December 2018 at two level I trauma centers (Pu-TC: Hospital Universitario del Valle, Pri-TC: Fundación Valle del Lili) in Cali, Colombia, were included. Multivariable logistic regression was used to assess for differences in in-hospital mortality, adjusting for relevant demographic and clinical characteristics. RESULTS: A total of 482 patients were identified; 300 (62.2%) at the Pri-TC and 182 (37.8%) at the Pu-TC. Median age was 27 years (IQR 21-36) and median Injury Severity Score was 25 (IQR 16-26). 456 patients (94.6%) were male, and the majority had penetrating trauma [total 465 (96.5%); Pri-TC 287 (95.7%), Pu-TC 179 (98.4%), p 0.08]. All patients arrived at the emergency room with unstable hemodynamics. There were no statistically significant differences in post-operative complications, including retained hemothorax [Pri-TC 19 vs. Pu-TC 18], pneumonia [Pri-TC 14 vs. Pu-TC 14], empyema [Pri-TC 13 vs. Pu-TC 13] and mediastinitis [Pri-TC 6 vs. Pu-TC 2]. Logistic regression did, however, show a higher odds of mortality when patients were treated at the Pu-TC [OR 2.27 (95% CI 1.34-3.87, p < 0.001]. CONCLUSIONS: Our study found significant statistical differences in clinical outcomes between patients treated at a Pu-TC and Pri-TC. The results are intended to stimulate discussions to better understand reasons for outcome variability and ways to reduce it.
BACKGROUND: The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma center (Pu-TC) and one private trauma center (Pri-TC). METHODS:Patients with thoracic trauma admitted from January 2012 to December 2018 at two level I trauma centers (Pu-TC: Hospital Universitario del Valle, Pri-TC: Fundación Valle del Lili) in Cali, Colombia, were included. Multivariable logistic regression was used to assess for differences in in-hospital mortality, adjusting for relevant demographic and clinical characteristics. RESULTS: A total of 482 patients were identified; 300 (62.2%) at the Pri-TC and 182 (37.8%) at the Pu-TC. Median age was 27 years (IQR 21-36) and median Injury Severity Score was 25 (IQR 16-26). 456 patients (94.6%) were male, and the majority had penetrating trauma [total 465 (96.5%); Pri-TC 287 (95.7%), Pu-TC 179 (98.4%), p 0.08]. All patients arrived at the emergency room with unstable hemodynamics. There were no statistically significant differences in post-operative complications, including retained hemothorax [Pri-TC 19 vs. Pu-TC 18], pneumonia [Pri-TC 14 vs. Pu-TC 14], empyema [Pri-TC 13 vs. Pu-TC 13] and mediastinitis [Pri-TC 6 vs. Pu-TC 2]. Logistic regression did, however, show a higher odds of mortality when patients were treated at the Pu-TC [OR 2.27 (95% CI 1.34-3.87, p < 0.001]. CONCLUSIONS: Our study found significant statistical differences in clinical outcomes between patients treated at a Pu-TC and Pri-TC. The results are intended to stimulate discussions to better understand reasons for outcome variability and ways to reduce it.
Authors: Joshua B Brown; Matthew R Rosengart; Timothy R Billiar; Andrew B Peitzman; Jason L Sperry Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Tessa Adzemovic; Thomas Murray; Peter Jenkins; Julie Ottosen; Uroghupatei Iyegha; Krishnan Raghavendran; Lena M Napolitano; Mark R Hemmila; Jonathan Gipson; Pauline Park; Christopher J Tignanelli Journal: J Trauma Acute Care Surg Date: 2019-06 Impact factor: 3.313
Authors: Júlio C U Coelho; Fabiana Marques Fernandes; Luís Gustavo G Cortiano; Gustavo Munhoz de Oliveira Leme; José Alfredo Sadowski; Christian Luiz Artner Journal: Rev Assoc Med Bras (1992) Date: 2010 Sep-Oct Impact factor: 1.209
Authors: Alberto García; Mauricio Millán; Carlos A Ordoñez; Daniela Burbano; Michael W Parra; Yaset Caicedo; Adolfo González Hadad; Mario Alain Herrera; Luis Fernando Pino; Fernando Rodríguez-Holguín; Alexander Salcedo; Maria Josefa Franco; Ricardo Ferrada; Juan Carlos Puyana Journal: Colomb Med (Cali) Date: 2021-05-10
Authors: Mauricio Millán; Carlos A Ordoñez; Michael W Parra; Yaset Caicedo; Natalia Padilla; Luis Fernando Pino; Fernando Rodríguez-Holguín; Alexander Salcedo; Alberto García; José Julián Serna; Mario Alain Herrera; Laureano Quintero; Fabian Hernández; Carlos Serna; Adolfo González Hadad Journal: Colomb Med (Cali) Date: 2021-04-08