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5. Impact of Center Volume on the Use of Status 2 Exceptions for Heart Transplantation.

Author

Thornhill, Rosanne, Blitzer, David, Lirette, Seth T., Carter, Kristen T., Mohammed, Asim, Baran, David A., and Copeland, Hannah

Subjects
HEART transplantation, TRANSPLANTATION of organs, tissues, etc., DATABASES, RETROSPECTIVE studies
Abstract

Objective: There are limited data examining the relationship between transplant center volume and their use of Status 2 exceptions for heart transplant (OHT). Methods: A retrospective review of the Organ Procurement and Transplantation Network (OPTN) database identified all patients undergoing OHT under Status 2 exception between late 2018 and early 2023. Demographics were collected and transplant centers were categorized based on the number of OHT performed annually (very low volume = < 5 OHT per year; low volume = 5–24 OHT per year; medium volume = 25–50 OHT per year, high volume = > 50 OHT per year). Results: Across all centers, 6348 OHT were included, with n = 68 performed at very low volume centers, n = 1001 performed at low volume centers, n = 1834 performed at medium volume centers, and n = 3445 performed at high volume centers. Medium and high volume centers applied for at least one Status 2 exception about 30%–35% of the time, compared to 50%–60% of the time observed at very low and low volume centers. Compared to very low volume centers, medium volume centers applied for half the amount of Status 2 exceptions (IRR = 0.52 [0.35–0.76]; p < 0.001) while high volume centers applied for less than half the amount (IRR = 0.42 [0.29–0.62]; p < 0.001). High‐volume centers were also 18% less likely to apply for exceptions than medium‐volume centers (IRR = 0.82 [0.74–0.91]; p < 0.001). Conclusions: Lower volume transplant centers apply for Status 2 exceptions at a significantly higher rate, with a stepwise decrease in exception use with increasing transplant center volume. [ABSTRACT FROM AUTHOR]

Published
2024
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14. Population Density and Triage of Pediatric Firearm Injuries in a Rural Trauma System

Author

Shaw, Taylor B., Cockrell, Hannah C., Carter, Kristen T., Mijalis, Eleni M., Buti, Yusef, Sawaya, David, Berch, Barry R., Kutcher, Matthew E., and Morris, Michael W.

Abstract

Background Rural pediatric firearm injuries require regional pediatric and trauma expertise. We evaluated county-level population density associations with transport, hospital interventions, and patient outcomes at a Level I pediatric trauma center serving a rural, statewide catchment area.Material and Methods The trauma registry of the only in-state pediatric trauma center was reviewed for firearm injuries in patients < 18 between 1/2013 and 3/2020. County-level population density was classified according to the United States Office of Management and Budget definitions for rural, micropolitan, and metropolitan areas.Results 364 patients were identified, including 7 patients who were re-injured. Mean age was 11.3 ± 4.5 y and patients were 79.4% male. 59.3% were transferred from a referring hospital. Median injury severity score was 5 (IQR 1-10); 88.0% required trauma center admission, and 48.2% required operative intervention. 7.4% were injured in a rural county, 46.4% in a micropolitan county, and 46.2% in a metropolitan county. Patients from rural counties were more likely to be unintentionally injured (72.0%) than those from micropolitan (54.4%) or metropolitan counties (44.0%, P= .04). While need for inpatient admission and length of stay were similar, those transported from rural counties had significantly longer transport times (P< .01) and less frequent need for operative intervention (P= .03), as well as trends toward lower injury severity (P= .08) and mortality (P= .06).Conclusion Management of pediatric firearm injury is a unique challenge with significant regional variability. Opportunities exist for outreach, telehealth, and decision support to ensure equitable distribution of resources in rural trauma systems.Level of Evidence Epidemiological, Level III.

Published
2023
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