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Biomedical subjects

William F Fallon

Publications and source records attributed to William F Fallon.

11 recordsLinked to original sources
PubMed2007

Autopsy data in the peer review process improves outcomes analysis.

BACKGROUND: The value of autopsy findings has been questioned in peer review at mature trauma centers. We sought to determine the impact of autopsy data on the peer-review process. METHODS: This was a retrospective study. Data analyzed included mortality type (immediate/dead on arrival [DOA]; early [< or =48 hours]; late [>48 hours]), Injury Severity Scale (ISS) score, Trauma and Injury Severity Score-generated probability of survival (PS), peer-review judgment of preventability, and findings at autopsy. Deaths were assigned to a category; then pre- and postautopsy ISS score, PS, and outcomes of the peer- review process (percent nonpreventable [%NP]) were compared. Paired t tests (alpha = 0.05) were performed to determine whether changes in ISS score and PS were statistically significant. All descriptive and inferential analyses were based on cases with pre- and postautopsy data for the relevant variables. RESULTS: Of the 170 deaths, 126 deaths had an autopsy performed (74.1%) and 112 autopsy reports were available (89.9%). Autopsy data resulted in statistically significant changes in ISS score for each mortality category and in PS for the immediate/DOA and early categories. There were also autopsy- related changes in peer-review outcomes for immediate/DOA and late deaths but not for early deaths. The proportion of overall agreement between pre- and postautopsy outcomes for the immediate/DOA category was 94.3% (50/53); three deaths initially deemed NP were reclassified as potentially preventable (PP) after autopsy. Overall agreement for the late category was 87% (20/23); one PP was reclassified as NP and two NPs were reclassified as PP. CONCLUSION: Autopsy data enhanced peer review in immediate/DOA and late death after injury but did not impact peer review in early deaths. Autopsy data were most important to the analysis of late deaths. Targeting autopsy performance to these mortality categories is an effective strategy for centers with constrained access to autopsy data.

Autopsy↗
PubMed2006

Geriatric outcomes are improved by a geriatric trauma consultation service.

BACKGROUND: Traumatic injuries in older patients are complex and have significant impact on the individual, their family, and trauma centers. We hypothesized that greater attention to the timely identification and comprehensive management of comorbid conditions would improve outcomes in the care of the older injured patient. METHODS: This was a prospective, descriptive study of all patients 65 years of age and older admitted to the trauma service. Each elder was seen by a specialist in geriatrics ideally within 24 hours of admission to the trauma service. A standardized consult was developed for the electronic medical record and utilized in every case. Data were obtained from the trauma registry to characterize the nature of injury, injury severity, and outcome. Data from the geriatric consult were compiled to determine the impact of age- associated conditions on the outcome. RESULTS: There were 285 injured patients, aged 65 years and older. Of these, 114 were seen in consultation. Age range was 65 to 96 years, with an average of 77.7 years. Injury Severity Score range was 3 to 75, with an average of 9.3. There were an equal number of male and female patients. Falls and motor vehicle collisions predominated. Geriatricians identified the following: 14% of patients presented with alcohol issues; 36% of patients exhibited signs of delirium; and 46% of patients presented with new medical conditions. Geriatricians assisted with advanced care planning in 15% of cases; disposition decisions to promote function in 49%; made medication changes in 65%; decreased inappropriate medications in 20%; and assisted with pain management in 42%. Trauma surgeons followed one or more recommendations in 91%. CONCLUSION: Outcomes of older patients can be improved through geriatricians' expertise by addressing new and existing medical issues and reducing hospital-acquired complications such as functional decline, falls, delirium, and death.

Aged↗
PubMed2006

Use of the Broselow tape may result in the underresuscitation of children.

OBJECTIVES: The purpose of this study was to determine the concordance of the Broselow tape with the measured heights and weights of a community-based population of children, especially in light of the increase in obesity in today's children. METHODS: The authors examined more than 7,500 children in a cross-sectional, descriptive study in two different cohorts of children to compare their actual weight with their predicted weight by a color-coded tape measure. RESULTS: In all patients, the percent agreement and kappa values of the Broselow color predicted by height versus the actual color by weight for the 2002A tape were 66.2% and 0.61, respectively. The concordance was best in infants, followed by school-age children, toddlers, and preschoolers (kappa = 0.66, 0.44, 0.39, and 0.39, respectively; percent agreement, 81.3%, 58.2%, 60.7%, and 64.0%, respectively). The tapes accurately predicted (within 10%) medication dosages for resuscitation in 55.3%-60.0% of the children. The number of children who were underdosed (by > or =10%) exceeded those who were overdosed (by > or =10%) by 2.5 to 4.4 times (p < 0.05). The tapes accurately predicted uncuffed endotracheal tube sizes when compared with age-based guidelines in 71% of the children, with undersizing (> or =0.5 mm) exceeding oversizing by threefold to fourfold (p < 0.05). CONCLUSIONS: The Broselow tape color-coded system inaccurately predicted actual weight in one third of children. Caregivers need to take into consideration the accuracy of this device when estimating children's weight during the resuscitation of a child.

Anthropometry↗
PubMed2005

Dollars and sense: attributing value to a level I trauma center in economic terms.

BACKGROUND: Reliable, accurate, program-specific data for hospital product lines are often difficult to obtain. The purpose of this study was to determine the impact that trauma center status has on hospital net income when compared with other traditional hospital product lines and services. METHODS: Over a 3-year period, financial data were collected for 16 payor classes: 8 major payors for all injury diagnoses, in-patient and out-patient. These data were analyzed by total charges, total direct costs, contribution margin, and net income. A key assumption of this strategy was that although injury patients are treated at most hospitals, only trauma center status allows access to patients and provision of services that can contribute significantly to the bottom line. RESULTS: Over the 3-year period, the contribution margin increased for trauma patients (excluding Level I trauma), Level I trauma patients, and the combined population of trauma patients. The most significant portion of the increase resulted from patients seen as a result of trauma center status. CONCLUSION: We conclude that, for our institution, the investment in resources necessary to achieve and maintain trauma center status makes economic sense in that the trauma program contributes favorably to hospital net revenue.

Ambulatory Care↗
PubMed2002

Delayed operative intervention in the management of traumatic descending thoracic aortic rupture.

BACKGROUND: Outcomes may be improved by purposefully delaying surgical intervention of the traumatically ruptured descending thoracic aorta. METHODS: Fifty-seven patient records identified through the Trauma Registry of a level 1 trauma center between January 1993 and April 2002 were retrospectively analyzed between groups who underwent "clamp-and-sew" versus partial left heart bypass repair techniques and between emergent versus delayed repair. RESULTS: Thirty-two (56%) of 57 patients were male. The mean age among survivors and nonsurvivors was 41 +/- 18 (range 13 to 70) and 52 +/- 23 (range 18 to 92; p = 0.04) years, and Injury Severity Score was 31 +/- 13 (range 17 to 75) and 40 +/- 16 (range 16 to 75; p = 0.04) points, respectively. Thirty-one (54%) underwent surgical intervention, 20 (35%) died during their initial resuscitation, and 6 (11%) were managed nonoperatively. Seventeen (55%) were repaired using partial left heart bypass and 14 (45%) using the clamp technique. Twenty-one (68%) had emergent repair and 10 (32%) had delayed repair. The rates of paraplegia, renal failure, and mortality were 12% (2 of 17), 0%, and 24% (4 of 17) in the bypass group, 0% (p = 0.29), 0%, and 36% (5 of 14, p = 0.36) in the clamp group, 9.5% (2 of 21), 0%, and 38% (8 of 21) in the emergent group (<24 hours after admission), and 0% (p = 0.45), 0%, and 10% (1 of 10, p = 0.12) in the delayed group (>24 hours after admission), respectively. Mean clamp times for the bypass and clamp groups were 44 +/- 18 (21 to 90) and 30 +/- 10 (14 to 52) minutes, respectively (p = 0.02). Overall operative mortality was 29% (9 of 31). CONCLUSIONS: Purposefully delaying surgical intervention in selected cases of descending thoracic aortic rupture and using the clamp technique does not increase mortality or morbidity over immediate operation and use of partial left hear bypass.

Adolescent↗
PubMed2002

Central retinal artery occlusion by proxy: a cause for sudden blindness in an airline passenger.

The use of gas media in ophthalmologic procedures is relatively commonplace. Scleral buckle and pneumatic retinopexy procedures using air-gas mediums are a widely accepted treatment for retinal detachment. We present a patient who had a scleral buckle with pneumatic retinopexy performed and subsequently flew in a commercial airliner 2 wk later. The patient experienced sudden blindness due to central retinal artery occlusion brought about by expansion of the air bubble when the aircraft reached cruise altitude and a cabin pressure of 8000 ft. The intraocular pressure exceeded the central artery pressure thereby collapsing the artery. The patient's symptoms were relieved when an onboard flight surgeon identified the problem and the cabin pressure was reset to 2000 ft. Flying after an ophthalmic procedure that incorporates intraocular gas may have complications due to the bubble expansion in accordance with Boyle's Law. The ophthalmologic surgeon must be diligent in forewarning patients of the potential complications of flying for weeks to months after a procedure that utilizes intraocular gas.

Adult↗
PubMedDate not supplied

Fetal evaluation for transport by ultrasound performed by air medical teams: A case series.

The air medical team has limited options when evaluating the obstetrical patient and assessing fetal health during air transport to a high-risk obstetrical unit. Traditionally, physical examination and a Doppler stethoscope have been used to determine fetal heart rates and movement. However, with the advent of portable ultrasound technology, new information about the mother and child are available to the air medical crew. The Fetal Evaluation for Transport with Ultrasound (FETUS) is a screening examination that consists of an evaluation of the fetal heart rate, position, and movement and general condition of the placenta. The examination can be repeated in flight with no acoustic distortion from rotor noise. The additional information can be advantageous when transport decisions need to be made or when conditions do not allow Doppler stethoscope use.

Adult↗
PubMedDate not supplied

Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium.

INTRODUCTION: The study purpose was to evaluate tracheal intubating conditions and cardiovascular effects of rocuronium (roc) and vecuronium (vec) in the transport setting. METHODS: A prospective blinded study of adult patients requiring emergency rapid sequence oral tracheal intubation using direct laryngoscopy. Patients received equipotent doses of roc 1.0 mg/kg (n = 44) or vec 0.15 mg/kg (n = 56) on an alternate day basis. RESULTS: Intubation was successful in 95% of patients in the vec group and 100% in the roc group. The percentage of patients having good or excellent jaw relaxation and vocal cord exposure was similar between groups (vec/79%, roc/77%). Eleven patients (vec/7, roc/4) had difficult intubation as evidenced by Grade III or IV view and more than three attempts. Five patients in the vec group had inadequate neuromuscular blockade versus 1 patient in the roc group (P = 0.17). No cardiovascular differences occurred between groups after intubation. CONCLUSION: Tracheal intubating conditions and clinical evidence of complete neuromuscular blockade tended to be better after roc than after vec.

Adult↗
PubMedDate not supplied

Intubated pediatric patients requiring transport: a review of patients, indications, and standards.

INTRODUCTION: We could not find any studies of nontertiary care facilities performing intubation for patients requiring transport to definitive pediatric care. The purpose of our study was to determine the current practices of pediatric airway management in the prehospital and transport environments. METHODS: A retrospective analysis of all patients younger than 16 years transported by our flight program during a 2-year period served as the population of interest. The flight records (RN and MD documentation) for intubated patients were analyzed for medications, methods, outcomes, and other descriptive endpoints. As a matter of program policy, all pediatric transports are subjected to peer review in the performance improvement committee. RESULTS: During the review period, 732 patients younger than 16 years (range: 30 days to 15 years) were transported by our flight program. Of the 148 (20%) patients intubated for airway control, 81 were boys (55%), and 67 were girls (45%). Sixteen percent were younger than 1 year, 24% were 1 to 2 years old, 18% were 3 to 5, 20% were 6 to 11, and 22% were 12 to 15. Indicators for intubation included unresponsiveness or arrest, 42 (28%); seizures, 38 (26%); respiratory failure, 28 (19%); decreased level of consciousness (LOC), 14 (9%); airway protection, 13 (9%); combativeness, 11 (7%); and other, 2 (1%). Children were intubated most frequently by the referring physician (92 children, 62% of patients). The flight crew performed 49 (33%) intubations, and EMS staff performed seven (5%). Three children were nasally intubated. Significant variation occurred in medications used, endotracheal tube size and position, and nasogastric decompression. No single group performed better or worse than the others in our review. CONCLUSION: Variability exists in the application of pediatric airway management techniques, including pharmacologic modes and intubation indications.

Child↗
PubMedDate not supplied

System thinking in a personal context to improve eating behaviors.

People can create positive environments so that their chances of relapse to poor habits are reduced and their likelihood of success is increased. Continuous quality improvement (CQI) suggests that this can be accomplished by making systemwide changes and deemphasizing personal effort. This article provides a 7-step approach to system thinking in a personal context. It offers a case study and other examples that show how to lose weight by making systemic changes in lifestyles. Learning about system thinking in a personal context also may help healthcare professionals understand the application of CQI within organizations.

Attitude to Health↗