Search

Abstract: Background: In April 2004 the Israeli Ministry of Health decided to condition DRG payment for hip surgery by time between hospitalisation and operation, giving a fine for every day's delay beyond 48h. An evaluation study performed 2 years after the reform has shown the positive influence of the reform on patient's survival in the hospital. This study evaluates the impact of the reform on the longer-term mortality of patients. Methods: A retrospective study based on data from nine hospitals of the national trauma registry available for the years 2001–2007, with surveillance on 2-year survival through data of Ministry of the Interior. The study population includes patients aged 65 and above with an isolated hip fracture following trauma. Mortality curves and Cox regression were utilised to compare the influence of different parameters on long-term mortality. Results: Earlier surgery had a significant positive impact on survival through the whole length of the study period. In the period after the introduction of the new reimbursement system for hip fracture surgeries, a significant decrease in the longer-term mortality was observed up to 6 months of follow-up, even when adjusted by patients’ age, gender and the receiving hospital. After 6 months there was no further decrease in relative risk, though the survival advantage remained with patients hospitalised after the reform. Conclusions: The reform appears successful in decreasing the longer-term patient mortality after hip fracture through influencing surgical practice. [Copyright &y& Elsevier]

Abstract: Objectives: Research has shown that early surgical intervention for hip fractures serves to decrease mortality. In 2004 the Ministry of Health decided to condition the reimbursement regime at the time of operation. The objectives of this study were to examine whether the reform succeeded to decrease inpatient mortality of hip fracture casualties. Method: The study utilised data drawn from the Israeli Trauma Registry (ITR) for the years 1999–2006. The study population included patients aged 65 and older with an isolated diagnosis of hip fracture following trauma. Results: Two years after the reform, the inpatient mortality decreased by 34% amongst patients undergoing fixation surgery, and by 30% amongst all operated patients. Median LOS decreased by 2 days. The proportion of patients undergoing hip fracture fixation surgery within 48h increased by 35%. Conclusions: The implementation of a payment limited by time for hip fracture fixation surgery increased the number of patients being operated within 48h, shortened patient LOS, and decreased inpatient mortality. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Research has shown that early surgical intervention for hip fractures serves to decrease mortality. In 2004 the Ministry of Health decided to condition the reimbursement regime at the time of operation. The objectives of this study were to examine whether the reform succeeded to decrease inpatient mortality of hip fracture casualties. Method: The study utilised data drawn from the Israeli Trauma Registry (ITR) for the years 1999–2006. The study population included patients aged 65 and older with an isolated diagnosis of hip fracture following trauma. Results: Two years after the reform, the inpatient mortality decreased by 34% amongst patients undergoing fixation surgery, and by 30% amongst all operated patients. Median LOS decreased by 2 days. The proportion of patients undergoing hip fracture fixation surgery within 48h increased by 35%. Conclusions: The implementation of a payment limited by time for hip fracture fixation surgery increased the number of patients being operated within 48h, shortened patient LOS, and decreased inpatient mortality. [Copyright &y& Elsevier]

Background: The destructive human consequences of terrorist bombing always challenge the medical system in diagnosis, decision making, and patient management. This injury is produced by multiple injury mechanisms, and departs from the conventional description of trauma complexity. Our objective was to characterize and compare terror-bombing victims with casualties of all other kinds of trauma, and to validate the existence of a different, more complex, injury pattern. Study design: A retrospective cohort study was conducted of patient records from October 2000 through June 2003 in the Israeli National Trauma Registry. All were categorized as victims of terrorist bombings or of nonterror-related trauma. Analysis included age, gender, Injury Severity Score, Glasgow Coma Scale, admission blood pressure, injury complexity, surgical interventions, intensive care and hospital lengths of stay, in-hospital mortality, and disposition. This analysis was extended to Injury Severity Score subgroups. Results: Victims of terrorist bombings (n = 906) were compared with 55,033 casualties of nonterror-related trauma. Bombing resulted in significantly different injury complexity, increased severity, and with more body regions involved. Significantly enhanced use of intensive care, prolonged hospital stay, more surgical interventions, and increased hospital mortality are characteristic of these patients. Conclusions: Terrorist bombings inflict injury of a distinctly different pattern than other means of trauma. The simultaneous combination of different injury mechanisms in explosions results in a multidimensional injury pattern and a complicated clinical course. Hospital preparedness and medical team awareness to the unique nature of the injuries are mandatory for improving the outcomes of these patients. (J Am Coll Surg 2004;199:875-879. [Copyright &y& Elsevier]

Objective: To compare demographic, injury and hospitalization characteristics and mortality between Isolated and Non-Isolated traumatic brain injury. Methods: A retrospective study based on the Israeli National Trauma Registry of patients hospitalized for traumatic brain injury (TBI) between 2008 and 2016. Isolated TBI was defined as no other anatomic region was having concomitant injury with AIS ≥2. X2 test and multivariate logistic regression analysis were used for data analysis. Results: Of the 23566-study population, 40.4% were admitted for isolated TBI. Isolated TBI was significantly more frequent in elderly aged ≥65 years, female, Jews, and injuries sustained at home or in residential institution. The Non-isolated TBI was greater in road traffic injuries, particularly among pedestrians and motor cyclists, and in violence injuries. The Non-isolated TBI group had greater injury severity and hospital resource utilization. In-hospital mortality was higher in the patients with Non-isolated TBI [OR: 1.56(95% CI: 1.33–1.83)], particularly in patients with GCS 13–15; elderly aged 65+ years; and patients with concomitant injuries to abdomen, spine or external body regions. Conclusion: In a patient with TBI, concomitant injuries with AIS ≥2 matter, and awareness of the identified factors has relevance for guiding injury prevention efforts and indeed for potentially improving care and outcome. [ABSTRACT FROM AUTHOR]

Introduction: The elderly experience higher mortality rates and poorer outcomes compared to younger burn survivors with similar injuries.Methods: This epidemiological study reviewed records of all admitted elderly burn patients collected from five burns facilities in Israel between 1997-2016. Collected data was limited to the population aged 20+, focused on the population aged 60+.Results: Mortality rates for elderly patients increased with TBSA and increases with age. Regression analyses demonstrated a decrease in mortality of 2.9% (p=0.013) per 5 years, an overall decrease of 11.6% over the 20-year study period, with the decline more significant for older age groups. This decrease in mortality was much larger than that observed for all burns patients over this period. The most common cause of injury in the elderly population was fire, with mortality rate highest for this cause. There was no effect of gender on mortality rate. Mortality increased when smoke inhalation was present for TBSA<20%, with mortality unaffected by the presence of smoke inhalation for higher TBSA. The need for surgery correlates with high mortality rates.Conclusion: This study identified key factors that impact mortality and demonstrated a large decrease in mortality in the elderly patients over the study period. [ABSTRACT FROM AUTHOR]

Aim: To assess the incidence and injury characteristics of hospitalized trauma patients diagnosed with TBI. Methods: A retrospective study of all injured hospitalized patients recorded in the National Trauma Registry at 19 trauma centres in Israel between 2002–2011. Incidence and injury characteristics were examined among children, adults and seniors. Results: The annual incidence rate of hospitalized TBI for the Israeli population in 2011 was 31.8/100 000. Age-specific incidence was highest among seniors with a dramatic decrease in TBI-related mortality rate among them. Adults, in comparison to children and seniors, had higher rates of severe TBI, severe and critical injuries, more admission to the intensive care unit, underwent surgery, were hospitalization for more than 2 weeks and were discharged to rehabilitation. After adjusting for age, gender, ethnicity, mechanism of injury and injury severity score, TBI-related in-hospital mortality was higher among seniors and adults compared to children. Conclusion: Seniors are at high risk for TBI-related in-hospital mortality, although adults had more severe and critical injuries and utilized more hospital resources. However, seniors showed the most significant reduction in mortality rate during the study period. Appropriate intervention programmes should be designed and implemented, targeted to reduce TBI among high risk groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. METHODS: A retrospective cohort study involving blunt trauma patients with rib fractures registered in the National Trauma Registry was conducted. RESULTS: Of 6,995 trauma victims who were found to suffer from rib fractures, 328 were children and 6,627 were adults. Isolated rib fractures without associated injuries occurred in 19 children (5.8%) and 731 adults (11%). More adults had 4 or more fractured ribs compared with children (P < .001). Children suffered from higher rates of associated brain injuries (P = .003), hemothorax/pneumothorax (P 5 .006), spleen, and liver injury (P < .001). Mortality rate was 5% in both groups. CONCLUSIONS: The incidence of associated head, thoracic, and abdominal solid organ injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries [ABSTRACT FROM AUTHOR]

Background: Previous analyses of the safety of the conservative versus the operative approach to the treatment of liver and spleen blunt injuries in children often failed to account for differences in quality of care and expertise among dedicated pediatric trauma center, non-pediatric centers, centers without trauma units, and non-trauma centers. To eliminate this potential bias, the present study examined changes in the rate of surgery and their impact on outcome within the same medical centers over time.Methods: The Israel Trauma Registry was searched for patients <18 years who were treated for non-penetrating liver or spleen injuries from 1998 to 2004. Patients were grouped by period, 1998-2000 and 2001-2004, and compared for type of injury, severity of injury, type of treatment, and inpatient mortality.Results: The earlier period (1998-2000) was characterized by a significantly higher rate of operations compared with the later period (2001-2004) (P = 0.001) and higher in-hospital mortality (P = 0.04). Injury severity scores, type of organs injured, and accompanying injuries were similarly distributed in the two groups.Conclusions: Despite the similarity in the severity and characteristics of the intraabdominal injuries in 1998-2000 and in 2001-2004, the proportion of children treated conservatively increased over time, concomitant with a significant drop in inpatient mortality. We attribute this shift over a relatively short interval to increased experience and greater acceptance of conservative management in this setting. [ABSTRACT FROM AUTHOR]