Abstract：
OBJECTIVES:(1) To demonstrate that a validated trauma triage score for middle-aged and geriatric patients could identify those at high risk of mortality within the first 2 days of hospitalization and (2) determine the cost of care for this cohort of patients. DESIGN:Prospective cohort study. SETTING:Single level 1 trauma center. PATIENTS:Patients 55 years of age and older who were evaluated in the emergency department setting by orthopaedics or who met the American College of Surgeons Tier 1-3 criteria. INTERVENTION:Calculation of validated trauma triage score, Score for Trauma Triage in Geriatric and Middle-aged patients, using patient's demographic, injury severity, and functional status; main outcome measurements: length of stay, inpatient mortality, time between presentation and time of death, and direct variable costs of hospitalization. RESULTS:A total of 1470 consecutive patients (mean age of 72.2 ± 11.9 years) were enrolled in this study, 17 of whom died within 48 hours of presentation to the emergency department. These patients had a significantly higher trauma triage score than the rest of the cohort with a score of 50.9% ± 37.2% versus 3.3% ± 9.5%, P < 0.001 indicating that they had a mean risk of inpatient mortality of over 50%. Mean total cost per day was much higher in the cohort of patients who died within 48 hours of admission compared with all other trauma patients [$49,367 ± $79,057 vs. $3966 ± $2897 (P = 0.031)]. CONCLUSIONS:To achieve value-based care in this high-risk cohort, targeted cost savings while improving patient outcomes and/or expediting goals-of-care and end-of-life goals is necessary and the STTGMA score allows for stratification of these patients in both mortality risk and cost profile.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Lott A,Haglin J,Saleh H,Hall J,Egol KA,Konda SRdoi
10.1097/BOT.0000000000001187subject
Has Abstractpub_date
2018-07-01 00:00:00pages
349-353issue
7eissn
0890-5339issn
1531-2291journal_volume
32pub_type
杂志文章abstract：OBJECTIVE:To review the outcome of patients with concurrent dorsal dislocations and fracture-dislocations of the second, third, fourth, and fifth carpometacarpal (CMC) joints treated with open reduction and internal fixation (ORIF). DESIGN:Retrospective review. SETTING:Level 1 trauma center. PATIENTS:Between 1991 an...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200111000-00003
更新日期：2001-11-01 00:00:00
abstract：OBJECTIVES:Far cortical locking (FCL) constructs have been shown to increase axial interfragmentary displacement while limiting shear and have been specifically recommended in the treatment of distal femur fractures. However, there is no available data regarding their mechanical behavior within the range of bridge span...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000001341
更新日期：2019-02-01 00:00:00
abstract：:Although opioids are widely used for the management of pain in patients with hip fracture, these medications are known to have a wide range of adverse effects that can result in suboptimal outcomes or serious life-threatening complications. Common opioid-related adverse events include gastrointestinal effects, central...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章,评审
doi：10.1097/BOT.0000000000000563
更新日期：2016-05-01 00:00:00
abstract：OBJECTIVE:To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. DESIGN:Case series. SETTING:Level I teaching trauma center. PATIENTS:Be...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0b013e31820af67f
更新日期：2011-11-01 00:00:00
abstract：OBJECTIVES:To determine how often preoperative testing is requested for geriatric hip fracture patients, to assess the extent to which preoperative testing is associated with delayed surgery, and to measure the frequency with which preoperative testing changes patient management. DESIGN:Retrospective. SETTING:Academi...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000000444
更新日期：2016-02-01 00:00:00
abstract：OBJECTIVE:To evaluate the outcome of patients with posterolateral tibial plateau fractures after open reduction and internal fixation with a fibula osteotomy-free posterolateral approach. DESIGN:Retrospective chart and operation note review. SETTING:A medical college-affiliated tertiary hospital. MATERIALS AND METHO...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000000047
更新日期：2014-09-01 00:00:00
abstract：:We present the case of an intraforaminal iliosacral screw placed percutaneously with aid of C-arm using inlet, outlet, and lateral views of the pelvis. The iliosacral screw was placed above the S1 foramen on the outlet view, into the middle of S1 via the ala on the inlet view, and below the cortical shadow of the ala ...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200502000-00010
更新日期：2005-02-01 00:00:00
abstract：PURPOSE:Radial head fractures are some of the most common elbow fractures. Fractures with 3 or more fracture fragments have been shown to have worse outcomes when treated with open reduction and internal fixation (ORIF). Radial head replacement offers an alternative treatment for those more comminuted radial head fract...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000001537
更新日期：2019-08-01 00:00:00
abstract：OBJECTIVES:Iliosacral screw pathways in the first (S1) and second (S2) sacral segments are commonly used for adult pelvic ring stabilization. We hypothesize that radiographically "safe" pathways exist in pediatric patients. SETTING:Academic level I Trauma Center. PATIENTS:All patients between ages 2 and 16 years with...
journal_title：Journal of orthopaedic trauma
pub_type： 临床试验,杂志文章
doi：10.1097/BOT.0000000000000421
更新日期：2016-01-01 00:00:00
abstract：OBJECTIVE:Ankle fractures are one of the most common operatively treated lower extremity fractures. Several studies indicate that patients often have residual effects after this injury. The purpose of this study is to use the SF-36 questionnaire at two times to assess patients' functional recovery and residual effects ...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200201000-00007
更新日期：2002-01-01 00:00:00
abstract：OBJECTIVES:To radiographically demonstrate the upper sacral nerve root tunnel (USNRT) in both cadaveric specimens and a clinical cohort and to quantify its clinical relevance. SETTING:Level 1 trauma center and anatomy laboratory. PATIENTS AND PARTICIPANTS:Eleven cadaveric pelves and 23 consecutive patients who underw...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0b013e3181a2e419
更新日期：2009-05-01 00:00:00
abstract：:Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Over 50% of the patients suffered concomitant ipsilateral knee injuries...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-199004030-00013
更新日期：1990-01-01 00:00:00
abstract：OBJECTIVE:To determine the biomechanical characteristics of four different fixation constructs for split depression fractures of the lateral tibial plateau (OTA classification 41B3.1). DESIGN:Laboratory investigation using a cadaveric simulated split depression tibial plateau fracture model. SETTING:Split depression ...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200203000-00006
更新日期：2002-03-01 00:00:00
abstract：OBJECTIVES:To evaluate the effect of both high-pressure pulsatile lavage and bulb syringe irrigation on the biomechanical parameters of fracture healing using an in vivo open noncontaminated diaphyseal femoral fracture model in rats. BACKGROUND:The utility of high-pressure pulsatile lavage irrigation on soft tissue de...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200207000-00008
更新日期：2002-07-01 00:00:00
abstract：OBJECTIVE:This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery. DESIGN:Prospective clinical series of consecutively treated patients. SETTING:Tertiary university hos...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0b013e31828e5d39
更新日期：2013-11-01 00:00:00
abstract：OBJECTIVES:To review the clinical course, complication rates, and mid-term functional outcomes associated with the treatment of displaced femoral neck stress fractures (FNSFs). DESIGN:Retrospective Case Series. SETTING:Military Tertiary Referral Center. PATIENTS:Twenty-one operatively treated displaced FNSFs between...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000001810
更新日期：2020-11-01 00:00:00
abstract：:Understanding complex acetabular fractures is difficult and may require three-dimensional reformatted computed tomographic (CT) images. This paper evaluates a technique, digital rotational imaging (DRI), that displays multiple oblique images of the pelvis and acetabulum. When viewed statically, DRI provides optimal il...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-199801000-00011
更新日期：1998-01-01 00:00:00
abstract：:American survivability during the current conflicts in Iraq and Afghanistan continues to improve, though the rate of extremity injury remains quite high. The decision to proceed with amputation versus limb salvage remains controversial. Exposure to combat wound with severe high-energy lower extremity trauma during the...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000000669
更新日期：2016-10-01 00:00:00
abstract：:Posterior wall (PW) fractures are the most common fractures requiring surgical fixation in acetabular surgery. Extra-articular screw placement must be confirmed intraoperatively. Herein we describe the use of the inlet and obturator oblique view (the Leeds view) for screw placement in elementary PW and in associated b...
journal_title：Journal of orthopaedic trauma
pub_type： 临床试验,杂志文章
doi：10.1097/BOT.0000000000000724
更新日期：2017-04-01 00:00:00
abstract：OBJECTIVES:To evaluate the outcomes of treatment with a percutaneous compression plate (PCCP) in stable and unstable intertrochanteric hip fractures. DESIGN:Clinical prospective nonrandomized cohort study. SETTING:San Cecilio University Hospital, Granada (Spain). A tertiary-care hospital. PATIENTS:Patients older tha...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000000509
更新日期：2016-06-01 00:00:00
abstract：:A 14 cm deficit of the tibia with a soft tissue deficit was resolved using the apparatus of Ilizarov. The apparatus was applied using a double corticotomy of the proximal and distal remainder of the tibia. The fragments were moved until they met each other in the central part of the deficit. Afterwards, a part of the ...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：
更新日期：1990-01-01 00:00:00
abstract：OBJECTIVE:To test the hypothesis that oblique screws at the ends of a plate provide increased strength of fixation as compared to standard screw insertion. DESIGN:Biomechanical laboratory study in synthetic bone test medium. METHODS:Narrow 4.5-mm stainless steel low-contoured dynamic compression plates were anchored ...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200410000-00006
更新日期：2004-10-01 00:00:00
abstract：:A case history of a trauma patient who developed a palsy of the marginal mandibular nerve from compression by a cervical spine hard collar is presented. After clinical and radiographic screening found no evidence of occult cervical spine pathology, the collar was removed; the palsy resolved uneventfully during the nex...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-199504000-00015
更新日期：1995-04-01 00:00:00
abstract：:Over a 15-month period, 41 open grade I-IIIA tibia fractures were treated with unreamed interlocking nails. A protocol previously established by the authors to enhance fracture union was followed. The purpose of the study was to determine if union rate for the comminuted statically locked fracture could be reduced thr...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-199504000-00005
更新日期：1995-04-01 00:00:00
abstract：OBJECTIVES:Noncompliance with postoperative follow-up visits remains a common problem in orthopaedic trauma. The aim of this study was to identify risk factors for loss of follow-up after orthopaedic trauma. DESIGN:Retrospective review. SETTING:Urban level 1 academic trauma center. PATIENTS:A total of 307 (226 men/8...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000000346
更新日期：2015-11-01 00:00:00
abstract：OBJECTIVE:To evaluate objectively the effectiveness of current surgical management of displaced acetabular fractures. To provide insight into how these evaluation methods can be used to identify areas in which improvements in surgery and rehabilitation can be pursued to improve patient outcomes. DESIGN:Consecutive cas...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-200202000-00001
更新日期：2002-02-01 00:00:00
abstract：:Four acute cases of volar carpometacarpal dislocations of the medial four metacarpals were treated in our hospital's emergency room. Our initial diagnosis after clinical examination was confirmed by routine x-rays of the hand. Closed reduction was followed by percutaneous fixation of the carpometacarpal joints with Ki...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-199809000-00019
更新日期：1998-09-01 00:00:00
abstract：OBJECTIVE:The treatment of some pelvic injuries has evolved recently to include the use of a subcutaneous anterior pelvic fixator (INFIX). We present 8 cases of femoral nerve palsy in 6 patients after application of an INFIX to highlight this potentially devastating complication to pelvic surgeons using this technique ...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000000193
更新日期：2015-03-01 00:00:00
abstract：OBJECTIVES:With value-based payment models on the horizon, this study was designed to examine the perceptions of value-based care among orthopaedic traumatologists and how they influence their practice. DESIGN:Systems-based survey study. SETTING:Orthopaedic Trauma Association (OTA) research surveys. PARTICIPANTS:OTA...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/BOT.0000000000001622
更新日期：2019-11-01 00:00:00
abstract：:Ipsilateral elbow and forearm fractures are quite rare in children. We present a Monteggia lesion with ipsilateral supracondylar humerus fracture in a 13-year-old girl. Through early surgical management, a successful result was achieved. We believe that, to minimize any initial or subsequent complications in such frac...
journal_title：Journal of orthopaedic trauma
pub_type： 杂志文章
doi：10.1097/00005131-199901000-00015
更新日期：1999-01-01 00:00:00
