The emergency department length of stay: Is the time running out?

Purpose: To examine the relationships between emergency department length of stay (EDLOS) with hospital length of stay (HLOS) and clinical outcome in hemodynamically stable trauma patients. Methods: Prospective data collected for 2 years from consecutive trauma patients admitted to the trauma resuscitation bay. Only stable blunt trauma patients with appropriate trauma triage criteria requiring trauma teamactivationwere included in the study. EDLOSwas determined short if patient spent less than 2 h in the emergency department (ER) and long for more than 2 h. Results: A total of 248 patients were enrolled in the study. The mean total EDLOS was 125 min (range 78 e180). Injury severity score (ISS) were significantly higher in the long EDLOS group (17 ± 13 versus 11 ± 9, p < 0.001). However, when leveled according to ISS, there were no differences in mean in diagnostic workup, admission rate to intensive care unit (ICU) or HLOS between the short and long EDLOS groups. Conclusion: EDLOS is not a significant parameter for HLOS in stable trauma patients.

CT as a first-line modality in elderly patients with stable blunt chest trauma

Blunt thoracic injuries are common among elderly patients and may be a common cause of morbidity and death from blunt trauma injuries.We aimed to examine the impact of chest CT on the diagnosis and change of management plan in elderly patients with stable blunt chest trauma.We hypothesized that chest CT may play an important role in providing optimal management to this subgroup of trauma patients.;A retrospective analysis was performed on all the admitted adult blunt trauma patients between January 2014 and December 2018.Stable blunt chest trauma patients with abbreviated injury severity(AIS)<3 for extra-thoracic injuries confirmed with chest X-ray(CXR)and chest CT on admission or during hospitalization were included in the study.The AIS is an international scale for grading the severity of anatomic injury following blunt trauma.Primary outcome variables were occult injuries,change in management,need for surgical procedures,missed injuries,readmission rate,intensive care unit(ICU)and length of hospital stay.;There are 473 patients with blunt chest trauma included in the study.The study patients were divided into two groups according to the age range:group 1:289 patients were included and aged 18-64 years;group 2:184 patients were included and aged 65-99 years.Elderly patients in group 2 more often required ICU admission(11.4%vs.5.2%),had a longer length of ICU stay(days)(median 11 vs.6,p=0.01),and the length of hospital stay(days)(median 14 vs.6,p=0.04).Injuries identified on chest CT has led to a change of management in 4.4%of young patients in group 1 and in 10.9%of elderly patients in group 2 with initially normal CXR.Chest CT resulted in a change of management in 12.8%of young patients in group 1 and in 25.7%of elderly patients in group 2 with initially abnormal CXR.;Chest CT led to a change of management in a substantial proportion of elderly patients.Therefore,we recommend chest CT as a first-line imaging modality in patients aged over 65 years with isolated blunt chest trauma.