AMERICAN TRAUMA SOCIETY MAY 2014

ATS INFORM INDUSTRY NEWS FROM AROUND THE TRAUMA ENVIRONMENT

Upcoming ATS Events June 5-6: ATS Trauma Registry Course – Washington, DC June 5-6: ATS Board of Directors Mid-Year Meeting - Falls Church, VA

In This Issue

Page 1 ATS News

Page 3 Injury Prevention News

Page 5 Industry News

Page 9 Trauma Research

Page 7 TSN Corner

SERVING AS AN ADVOCATE FOR THE TRAUMA CARE SYSTEM, TRAUMA

PREVENTION PROGRAMS, AND THE VICTIMS OF TRAUMA AND THEIR

FAMILIES THROUGHOUT THE UNITED STATES FOR OVER 45 YEARS

1st National Trauma Survivors Day Social Media Campaign – A Success!

The Trauma Survivor’s Network (TSN) established Trauma Survivor’s Day a decade ago during National Trauma Awareness Month, to celebrate and honor patients and families recovering from their injuries.

This year, to compliment many of the celebrations happening around the country, the ATS and TSN established an online media campaign to support survivors and their dedication, perseverance and commitment to recovery.

Using the hash-tag #traumasurvivorsday, patients, families, doctors, nurses, specialists, EMTs and others that are involved in the recovery process, posted messages and photos to Facebook,

Twitter, Instagram and via email.

The inaugural social media campaign this year yielded over 200 photos, and over 425 messages posted from around the country. Most importantly was the tremendous outpouring of support for trauma survivors recovering from their injuries. The encouragement does not have to stop here. Continue to send messages and pictures to the TSN site. Share your stories of survival. Establish a TSN program at your facility. For more information, please visit www.traumasurvivorsnetwork.org

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

Did you Know? High school athletes account for an estimated 2

million injuries and 500,000 doctor visits and 30,000 hospitalizations each year.

More than 3.5 million kids under age 14 receive medical treatment for sports injuries each year.

Children ages 5 to 14 account for nearly 40 percent of all sports-related injuries treated in hospitals. On

average the rate and severity of injury increases with a child's age.

Each year U.S. Emergency Departments treat an estimated 135,000 sports- and recreation- related traumatic brain injuries, including concussions.

Almost 50 percent of head injuries sustained in sports or recreational activities occur during bicycling,

skateboarding, or skating incidents.

Acute meniscal tears are common affecting 61 out of 100,000 persons per year.

70,000 shoulder dislocations connected with sports or recreational activities occur each year.

ATS Congratulates Joe Schmider on State Director Appointment to FICEMS U.S. Public Law 109-59 authorizes the Federal Interagency Committee on Emergency Medical Services (FICEMS), an entity that is tasked to ensure coordination among the Federal agencies involved with State, local, tribal, or regional EMS and 9-1-1 systems. ATS recently learned that our member, Joe Schmider was appointed by Transportation Secretary Foxx to

fill the position reserved for a State EMS Director. Schmider has been active in EMS for many years while serving in a variety of positions from PA to TX and is well qualified to fill the shoes of retired FICEMS (and ATS Board) member, Dr. Robert Bass. Please join us in congratulating Joe on this important accomplishment!!

May is National Trauma Awareness Month

The Association’s website is in need of replacement, and plans are in place to transition to a new site in the coming weeks. We’ve been hard at work on the new ATS website, which is scheduled to launch early this summer. The new system fully integrates with our membership

management system, proving

improved services to our members, and

members-only capabilities. We will also soon be transitioning to

E-Invoicing, allowing

members to easily renew their dues and keep track of

renewal dates. The new site will have a fresh new look and feel, improved navigation, more information on all of the ATS courses, services and resources, prominent access to social media, improved networking opportunities, and so much more! We want to make sure that the new website integrates as many desired features as is possible within the parameters given. If you have comments or complaints about the current site or would like to offer your input/suggestions for the new site, please feel free to email, Executive Director Ian Weston at iweston@amtrauma.org

New ATS Website Coming Soon

Click here to view and download NTAM materials on sports injuries.

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

The American College of Physicians (ACP_ recommends counseling patients on the risks of keeping firearms in their homes, especially when minors or people with dementia, mental illness, or substance use disorders live there. In a new position paper published in the Annals of Internal Medicine, the group says that physicians should also counsel patients on the best practices to reduce firearm-related injuries and deaths. The ACP also supports regulating the purchase of firearms to reduce injuries and deaths, including universal background checks, waiting periods, and banning assault weapons.

“Injuries Change the Way You Approach

the Game”

American College of Physicians Recommends Physicians Take Steps to Reduce Gun Violence

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According to a new report published earlier this month, more fatal unintentional drowning occurs in young black pool-goers than in white, Hispanic, and Asian youth. The rate of swimming pool drowning for black children ages 5 to 19 is more than five times that of white children. The report

published in the CDC’s Morbidity and Mortality Weekly Report, discusses research that has long shown a higher risk of drowning in pools among blacks, and drowning is a major cause of death for all children. The ethnic gap in drowning rates is smaller outside of pools, and experts suggest that fewer blacks participate in boating and other open water activities. For whites, toddlers are the most vulnerable to drowning, but the risk drops

by about age five and remains lower. This is thought to be attributable to a higher tendency for white parents to enroll children in swimming lessons at an early age. Black toddlers experience fewer drowning’s, but the rate never falls as children get older. Earlier research found that almost 60 percent of black children polled did not know how to swim or lacked confidence in deeper pool water. In white children polled, this number was only 31 percent. According to CDC surveillance data on children and young adults, Hispanics and whites have similar drowning rates while Asians are

Racial/Ethnic Disparities in Fatal Unintentional Drowning

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slightly lower. The drowning rate for blacks is 40 percent higher and topped only by the rate for American Indians and Alaska Natives, which are nearly twice as likely to drown than whites. Another CDC study released this week reported that between 3,000 and 5,000 people suffer injuries that require emergency room visits from exposures to pool chemicals. Nearly half of these are children under age 18.

Hospitals implementing measures from the Joint Commission Center for Transforming Healthcare's "Preventing Falls with Injury" project reduced the number of patient falls by more than one-third. Additionally, hospitals reduced the

number of patients injured in a fall by 62 percent. Participating hospitals volunteered to implement the project, which involved empowering patients to play a role in their safety, complete a fall risk assessment, include patients and families in the fall safety program and creating awareness among staff. They used Robust Process Improvement to identify causes and develop solutions to prevent patient falls. Applying these statistics to an average 200-bed hospital, the Center estimates a hospital could save $1 million annually through fall prevention efforts. A 400-bed hospital could save $1.9 million annually, it estimates. The Joint Commission is currently developing a Targeted Solutions Tool for preventing falls with injury. The TST is expected to be released in 2015.

Joint Commission Project Reduced Patient Falls by 35% Joint Commission Center for Transforming Healthcare – April 28, 2014

Injury Prevention News

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

People in the southeastern United States have a much greater risk of dying early from any of the nation's five leading causes of death, federal health officials reported. Those living in eight southern states -- Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee -- endure 28 percent to 33 percent of all potentially preventable deaths from heart disease, cancer, chronic lower respiratory disease, stroke and unintentional injury, according to U.S. Centers for Disease Control and Prevention estimates. The top five causes of death accounted for nearly two-thirds of all U.S. deaths in 2010, and nearly 900,000 Americans die prematurely every year from these causes, the CDC said. Death rates for each cause of death vary greatly from state to state. So CDC researchers compared all states against the states with the lowest rates of death to estimate how many deaths could be prevented if those low rates were a national trend. According to the CDC, it should be possible on a national basis to prevent: § 34 percent of premature deaths from heart disease, prolonging about 92,000 lives. § 21 percent of premature cancer deaths, prolonging about 84,500 lives. § 39 percent of premature deaths from chronic lower respiratory diseases, prolonging

about 29,000 lives. § 33 percent of premature stroke deaths, prolonging about 17,000 lives. § 39 percent of premature deaths from unintentional injuries, prolonging about 37,000

lives.

These numbers are particularly important for the southeastern states, which led the nation with the highest numbers and rates of preventable deaths in all five top causes of death. The southeastern states have a combination of unhealthy trends that increases the overall risk of premature death, including higher smoking rates, greater obesity rates, lower rates of physical activity and less blood pressure control, the CDC commented.

Kid’s Concussion Symptoms Can Linger

Long After Injury: Study Health Day – May 12, 2014

Kids who suffer a concussion can have lingering effects long after the physical symptoms fade away, researchers report. In a study from the emergency medicine division at Boston Children's Hospital, doctors found that, while headache, dizziness and blurry vision can appear right after a concussion, emotional and mental symptoms, such as irritability and frustration, show up much later and stay longer. For the study, published online May 12 and in the June print issue of Pediatrics, the research team used questionnaires to keep track of 235 children and young adults, aged 11 to 22, who suffered a concussion and went to a pediatric emergency department. The patients were followed for three months after their injury, or until all their symptoms were gone. During that time they were asked about symptoms, sports activity, and school and athletic performance. The most common physical symptoms were headache, dizziness and fatigue, which tended to start right after the injury and got better over time. Most also had mental symptoms, such as difficulty concentrating and taking longer to think, the researchers found. While most children recovered within two weeks after the injury, 25 percent still had headache a month after their injury, the investigators found. In addition, more than 20 percent suffered from fatigue, and nearly 20 percent reported taking longer to think for a month after their concussion. For many, emotional symptoms -- such as frustration and irritability -- were not as common right after the injury, but developed later, the study authors noted.

Southeastern States Have Highest Rates of Preventable Deaths Health Day – May 1, 2014

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Falls are the leading cause of injury-related morbidity and death among older adults, and arthritis significantly increased both falls and fall injuries, researchers reported in an article published in the May 2 issue of the Morbidity and Mortality Weekly Report. Researchers from the CDC recommended interventions that use exercise or physical therapy to improve gait, balance, and lower-body strength. Using data from the 2012 Behavioral Risk Factor Surveillance System, ‘the age-adjusted median prevalence of one fall, any fall, two or more falls, and fall injuries was 28 percent, 79 percent, 137 percent, and 149 percent higher (relative differences), respectively, among adults with arthritis compared with adults without arthritis,’ the authors report. Age-adjusted median prevalence of fall injuries was 2.5 times higher among adults with arthritis. Furthermore, among adults with arthritis, 46 states and the District of

Arthritis May Double Risk for Fall-Related Injury Morbidity and Mortality Weekly Report – May 2, 2014

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

Air bags and seat belts help protect the kidneys from damage during car accidents, new research shows. Researchers from Advocate Illinois Medical Center, Baylor College and New York University reached their conclusions after examining car accident statistics in the United States from 2010 to 2011. There were nearly 300,000 car accidents, according to the researchers. In those accidents, almost 2,600 kidney injuries occurred. People who used air bags and seat belts together were about 23 percent less likely to suffer from severe kidney injuries, and their rates of nephrectomy -- surgical removal of a kidney -- fell by more than half. However, injured people who only wore a seat belt or used an air bag -- and not both -- weren't that much less likely to suffer a severe kidney injury. People who don't use seat belts and who don't have air bags in their car were 44 percent more likely to suffer a serious kidney injury during a car accident, according to the study.

NACCHO Releases Medical Reserve Corps Profile

Trauma Industry News

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Columbia had an age-adjusted prevalence of any fall in the past 12 months of 30 percent or higher, and 16 states had an age-adjusted prevalence of 40 percent or higher. In contrast, no state or territory had an age-adjusted prevalence of falls of 30 percent or higher in adults without arthritis. The authors note that public health approaches to fall prevention have focused on modifying risk factors such as leg muscle weakness, gait and balance problems, poor vision, environmental hazards such as slippery surfaces, and psychoactive medication use. “Effective fall prevention interventions can be multifaceted, but the most effective single strategy involves exercise or physical therapy to improve gait, balance, and lower body strength, which have been shown to reduce fall risk by 14 percent –37 percent,” the authors write. Effective exercise interventions were focused on improving balance, became progressively more challenging, and required at least 50 hours of practice, such as twice-weekly 1-hour Tai Chi classes.

Arthritis Continued….

Seat Belts, Air Bags May Save Your Kidney’s Health Day – May 16, 2014

Doctors Call for Stricter Limits on Checking In Youth Hockey Reuters Health – May 28, 2014

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Body checking should be kept out of youth hockey until boys are at least 15 years old, pediatricians said. Even then, they added, it should be restricted to the highest levels of competition. According to the new American Academy of

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Pediatrics (AAP) policy statement, checking is related to a higher risk of injury across all levels of boys' youth ice hockey. Checking is not allowed in girls' hockey. A "check" involves a player hitting a skater on the opposing team to

try to separate him from the puck. USA Hockey, the sport's governing body in the U.S., currently allows checking in leagues for boys ages 13 and older. That's up from a minimum age of 11

before the 2011-2012 season. The AAP recommended in 2000 that checking not be allowed in hockey leagues for children ages 15 and younger. But at the time, there wasn't a lot of data to support that position. "In the last 10 years there's been a lot of great research that's come primarily out of Canada to provide a strong scientific evidence base that body checking dramatically increases risk of injury, severe injury and concussion," the AAP commented. Some of those studies, suggested being in a league that allows checking triples or quadruples a young person's risk of sustaining a concussion. In the new statement, the AAP Council on Sports Medicine and Fitness says that checking skills can be taught in practice starting at age 13 for those players that are headed to the more elite levels of youth hockey. The group also calls for reinforcement of rules that prohibit an athlete from making contact with another player's head or checking him from behind - both of which also increase the risk of serious injury.

The National Association of County and City Health Officials (NACCHO) recently released Stronger Together: The 2013 Network Profile of the Medical Reserve Corps. The Medical Reserve Corps (MRC) is a national network of over 200,000 volunteers organized into nearly 1,000 local units across the United States and was formed after the Sept. 11, 2001 attacks as a way for citizens to respond after a crisis. The report reflects information about the structure and operations of each local unit, unit leader and volunteer demographics, activities, training, unit administration, communication, partnerships, legal protections, and finances.

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

The Agency for Healthcare Research and Quality (AHRQ's) Effective Health Care Program recently released Registries for Evaluating Patient Outcomes: A User's Guide: Third Edition, a new publication to support the design, implementation, analysis, interpretation and quality evaluation of registries created to increase understanding of patient outcomes. This project expands the second edition to address 11 new topics in registry methodology and updates existing chapters to cover new legislation and other changes in registry science. Real-world contemporary case examples are provided to illustrate key principles of registry design, operation and evaluation and to demonstrate different strategies and perspectives to address common challenges. The third edition can be downloaded for free from the Effective Health Care Program website and soon will be available in file formats designed to be read with eBook readers, such as Nook, Kindle and iPad.

AHRQ Releases Patient Outcomes Project

IOM Health Professional Education Workshop Summary Now Available

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The 50-year-old man loaded bullets and shot his mom's surgeon, David B. Cohen, MD, in the stomach, then fired twice more -- into his mother's skull and then his own. The shooter and his mother both died, and locked down the Johns Hopkins Hospital in Baltimore, MD for over 3 hours. That attack and suicide in September 2010 planted the seed for hospital shooting research and a day-long symposium last month at Johns Hopkins about how staff should prepare and react to gunfire in hospitals. An expert panel at the symposium plans to issue national guidance this fall. This was not an isolated incident. In a 2012 Annals of Emergency Medicine study, researchers found 154 hospital shootings from 2000 to 2011 across 40 states -- and roughly 30 percent occur in emergency departments. Healthcare workers have to be trained to react differently to gun

Submit an Article for the INOFRM Newsletter

Have a successful injury prevention program, innovative research your facility is actively engaged in, important news affecting our industry? Your ATS peers want to hear from you. Submit an article for the ATS INFORM Newsletter. Email us at info@amtrauma.org.

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violence, according to an American Journal of Disaster Medicine study about how to prepare staff for active shooters in the ED. Perhaps it's obvious, but it's important that each department have a plan in place so that people know how to respond swiftly and effectively, experts say. Not everyone will know how to react, but there must be some staff trained to respond correctly. Everyone needs to know who is in

How to Survive a Hospital Shooting MedPage Today – May 1, 2014

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Assessing Health Professional Education is the summary of a workshop hosted by the Institute of Medicine's Global Forum on Innovation in Health Professional Education to explore assessment of health professional education. At the event, Forum members shared personal experiences and learned from patients, students, educators, and practicing health care and prevention professionals about the role each could play in assessing the knowledge, skills, and attitudes of

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all learners and educators across the education to practice continuum. The workshop focused on assessing both individuals as well as team performance. This report discusses assessment challenges and opportunities for interprofessional education, team-based care, and other forms of health professional collaborations that emphasize the health and social needs of communities.

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charge in the situation. And those plans must include which medical teams will be the first responders for casualties. There's no consensus among ethicists about how physicians should weigh personal safety in these situations. Healthcare providers need to remember the goal to provide the "most good for the most people."

New Treatment Regenerates Muscle Lost In Traumatic Injury Medscape – May 1, 2014

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Doctors have succeeded in coaxing the regeneration of muscle tissue lost in people who suffered traumatic injuries, including wartime bomb wounds, with a new type of treatment that uses material from a pig's bladder. Implanting the pig material at the wound site enticed the patient's own stem cells - master

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

War Wounds: Hearing Loss Tracks Gulf War Vets

MedPage Today – May 25, 2014

Time in service -- either as an active duty, Reserve, or National Guard member -- is associated with an increased risk of auditory injuries, including hearing loss, tinnitus and hyperacusis, and those injuries can negatively affect veterans' quality of life for years to come. At least 1.5 million veterans suffer from military-related hearing impairment. Tinnitus and hearing loss, in fact, are the two most common service-related disabilities. Auditory injuries are so prevalent among veterans that they have been called "the No. 1 war wound." Moreover, unlike in the general population where hearing loss is more common in older individuals, auditory injuries are

startlingly common among younger veterans who have served in Afghanistan and Iraq. According to the Hearing Health Foundation, 60 percent of veterans who served in Afghanistan and Iraq returned home with hearing loss and/or tinnitus. Yet, because auditory injuries are often not readily apparent, they are frequently overlooked.

TSN Corner

Patients with paralysis may be able to improve control of prosthetic arms using proprioception, a new study suggests. In this report, a patient with quadriparesis was able to manipulate a virtual reality arm without seeing it with the addition of proprioceptive feedback provided by a computer analyzing actual movement data. "Adding proprioceptive feedback alone significantly improves her ability to perform a task," said researchers from the University of Pittsburgh in Pennsylvania. Proprioception — the awareness of the position of one's own body — is a crucial component of the motor control system, the researchers note, and loss of proprioceptive input leads to gross deficits in

motor performance. Proprioceptive feedback is beneficial during motor learning in rehabilitation following brain injury. Patients lacking proprioception who had deficiencies in arm movements had significant limitations in their ability to make reaching movements without visual guidance, the authors note. Patients can control prosthetic arms with a brain–computer interface (BCI) implanted in the brain. However, BCI-controlled prosthetics currently operate without sensory feedback. Instead, patients using BCI must rely on their vision to move these prosthetic limbs. To address that gap, the researchers implanted two 96-channel microelectrode arrays into a patient's motor cortex. The patient had complete paralysis with essentially intact sensation. The patient used an exoskeleton around her arm to provide

input to the computer. She also had an assistant who moved her arm manually. This input allowed the computer to understand which signals from her brain translated to motions of her arm. The computer then provided a virtual-reality image of an arm moving on a monitor. The patient was able to manipulate the virtual-reality arm with these signals from her brain.

Proprioception May Enhance Prosthetic Arm Function

Medscape – April 10, 2014

U.S. Army Sgt. Gary Walters was actually relieved when his lower right leg was finally amputated because it reduced the excruciating pain. But when his prosthetic started causing him problems, the resourceful vet invented a solution to make sure he could live suffering-free. While serving in Iraq in 2005, he was severely injured by an improvised explosive device. His doctor urged him to avoid the amputation route, but when the pain grew to be too intense -- Walters had his lower right leg amputated. At first it was a relief, and he was walking on his new prosthetic within six weeks. But the prosthetic, as is the case with most amputees, didn’t allow the amputated limb to breathe enough, causing Walters to experience discomfort and sometimes have to take a break from using the artificial limb altogether. When Walters told his doctor about his discomfort, the physician recommended applying additional deodorant to the affected area. There was simply no other solution available. At the time, Walters was studying engineering at the University of Texas at San Antonio. So, he decided to propose developing a cooling device for prosthetics for his capstone project. He, along with his fellow student-teammates, developed a way to keep the area between the limb and prosthetic socket dry, a system that has now developed into the Aquilonix prosthetic cooling system.

After four-time X Games medalist Mike Schulz had his left leg amputated after a snowmobile accident in 2008, he was determined to get right back in the game, CNN reported. But after learning that there was no prosthetic available that would grant him the kind of mobility he needed -- he wasn’t dismayed. He went out and invented one himself. He started tinkering with equipment and eventually developed the Versa Foot, a prosthetic that allows amputees to partake in a number of extreme sports, including snowmobiling, snowboarding and wakeboarding. He, like Walters, is now helping other amputees live a more fulfilling and active lifestyle.

Prosthetics Just Got Much More Comfortable, Thanks to This Forward-Thinking

Injured Vet Huffington Post – May 8, 2014

National Trauma Survivors Day – A Family Affair

Eileen Flores (R) the TSN Coordinator at Carolinas Medical Center, celebrated NTSD with her Dad (L), a trauma survivor.

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Weekly emails to hospital leaders including C-suite members and department heads may have helped bring down the rate of new infections from carbapenem-resistant Acinetobacter baumannii at a large public hospital, according to an article published in the May issue of the American Journal of Infection Control. From January 14, 2011, through March 30 2012, Dr. Munoz-Price, the medical director of infection control at the University of

Miami-Jackson Memorial Medical Center, sent weekly emails to hospital leadership describing, interpreting, and summarizing the previous week's findings from surveillance cultures, environmental

cultures, environmental disinfection, and hand cultures. The emails also explained environmental initiatives taken during the week. In addition, the infection preventionist sent daily emails detailing acquisitions of infections and the locations of existing carbapenem-resistant A baumannii–positive patients to managers in intensive care units that had the highest number of infection acquisitions. The daily emails went to the nursing and medical directors, nurse managers, nurse educator, respiratory therapy manager, and director of environmental services. They found that overall hospital infection acquisition rates declined from 5.13 per 10,000 patient-days in the period before the weekly emails to 1.93 patient-days in the period after the intervention. Infection acquisition rates declined from 67.15 to 17.4 in the medical intensive care unit and from 55.9 to 14.71 in the trauma intensive care unit.

Weekly Emails Linked to Lower Trauma Center Infection Rates AJIC – May 12, 2014

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The rate of trips to US emergency departments (EDs) resulting from traumatic brain injury (TBI) rose almost 30 percent between 2006 and 2010, according to a research letter published online May 13 in JAMA. The University of Pittsburgh School of Medicine, Pennsylvania, conducted a population-based epidemiological study of TBI visits to US EDs from 2006 through 2010. They analyzed data from the Nationwide Emergency Department Sample database, which collects data on 25 to 50 million ED visits from more than 950 hospitals yearly and represents 20 percent of all US EDs. The researchers found that the rate of TBI visits per 100,000 person-years increased 29.1 percent, going from 637 in 2006 to 822 in 2010. By comparison, the rate of total ED visits for the period rose 3.6 percent, going from 40,228 visits per 100,000 person-years in 2006 to 41,691 visits in 2010. Children younger than 3 years and adults older than 60 years accounted for most TBI ED visits. The researchers suggest this may be because “these age groups do not benefit as much from public health interventions, such as concussion and helmet laws and safer sports' practices.” The total number of ED visits coded as TBI in the Nationwide Emergency Department Sample database came to more than 2.5 million in 2010.

Traumatic Brain Injury ED Visits Up Nearly 30% in 5 Years JAMA – May 13, 2014

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cells that can transform into various kinds of cells in the body - to become muscle cells and regenerate tissue that had been lost, the researchers said. The study, from the University of Pittsburgh, was small, involving only five men, but its results suggested that this procedure could offer new hope to a category of patients, including troops who suffered major war injuries, with scant good treatment options, they added. All five patients, including two U.S. soldiers hurt by bombs planted by insurgents, had badly damaged leg muscles. The research was backed by $3 million in funding over five years from the U.S. Defense Department.

Regeneration Continued….

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For the first time, the majority of US prescriptions — not including those for controlled substances — were routed electronically to pharmacies through Surescripts in 2013, according to the company's National Progress Report on health information technology (IT). That's more than one billion prescriptions, or 58 percent of all noncontrolled-substance, eligible prescriptions written last year. The total volume of prescriptions routed online increased 32 percent to 1.04 billion in 2013 from 788 million in 2012, according to Surescripts. By comparison, the growth rate in the number of e-prescribers was much lower. Seventy-three percent of office-based physicians prescribed electronically last year

Over Half of Prescriptions Go Online for the First Time in 2013 Medscape – May 23, 2014

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

Trauma Research News

Almost 80 percent of doctors in the United States have switched from paper to electronic health records, new government statistics show. By 2012, almost 72 percent of physicians had made the change, compared to just under 35 percent in 2007, according to the report from the U.S. Centers for Disease Control and Prevention. Since then, the number of doctors using electronic health records has increased even more. However, many doctors (about 40 percent) aren't using the full capabilities of their system, Hing noted. Once the system is installed, there is a steep learning curve before doctors and other staff are able to use it efficiently, according to CDC officials. Basic systems keep track of patient data, prescriptions and lab test results. More advanced features can graph patient tests to note trends and keep track of changes in the patients' health over time. Of the doctors who turned to electronic health records by 2012, 39.6 percent used a basic system, up from 11.8 percent in 2007, the researchers found. And 23.5 percent had a fully functional system, up from 3.8 percent in 2007, according to the findings published May 20 in the CDC's National Health Statistics Reports.

Doctors’ Use of E-Records More Than Doubles Health Day – May 28, 2014

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Older Blacks Fare Better Than Whites After Trauma JAMA Surgery – May 20, 2014

Younger blacks have higher in-hospital mortality after trauma than whites, but the situation is reversed for trauma patients aged 65 years and older, according to an article published online May 28 in JAMA Surgery. Researchers from the Center for Surgical Trials and Outcomes Research, at Johns Hopkins School of Medicine in Baltimore, Maryland, analyzed the records of more than 1 million trauma patients in the United States who were hospitalized between January 1, 2003, and December 30, 2010. They used data from the Nationwide Inpatient Sample to identify trauma patient records by diagnosis, and the International Classification of Diseases Programs for Injury Categorization (ICDPIC) to assess injury severity for each patient. They also analyzed demographic data, head injury severity, and comorbidities. The deidentified patient population consisted of 502,167 patients aged 16 to 64 years and 571,028 patients aged 65 years or older. The unadjusted odds ratios (ORs) for death in blacks vs whites was 1.35 for younger patients and 1.00 for older patients. After adjusting for variables including age, sex, insurance coverage, injury type and severity, and head injury severity, the ORs for blacks vs whites was 1.21 for younger patients and 0.83 for older patients. Of the older patients, most (95.8 percent) were white, female (71.1 percent), and had insurance (99.4 percent). Most older patients experienced blunt (99.6 percent) or unintentional (99.7 percent) trauma that resulted in severe injuries (61.7 percent). Most younger patients had no comorbidities (79.7 percent), whereas less than half (43.3 percent) of the older patients had no comorbities. More than 25 percent of older patients had more than 1 comorbidity.

Prescriptions Continued….

Epinephrine May Be of No Survival Benefit in Cardiac Arrest Resuscitation – May 2014

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A meta-analysis shows similar survival to discharge and neurological outcomes in adult cardiac arrest patients irrespective of epinephrine use or dose. Standard advanced cardiac life support guidelines recommend administration of epinephrine at a dose of 1 mg every 3 to 5 minutes, but is there evidence that this therapy improves outcomes? To answer this question, researchers performed a meta-analysis of 14 randomized, controlled trials (12,250 total patients) in nine countries that compared standard-dose epinephrine with high-dose epinephrine (>1 mg per dose), vasopressin, or placebo in adults with out-of-hospital cardiac arrest. Rates of survival to hospital admission and return of spontaneous circulation were higher with high-dose epinephrine than with the standard dose and were lower with placebo than with the standard

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versus 69 percent in 2012. In previous years, adoption increased much more rapidly. The adoption of new technology, coupled with the modest rise in the number of e-prescribers, means that e-prescribers are writing and sending more prescriptions electronically. Another factor that positively impacted both e-prescribing adoption and volume, were government programs that incentivized physicians to e-prescribe. The meaningful-use electronic health record (EHR) incentive program required doctors to send 40 percent of their prescriptions online in Stage 2. And the e-prescribing program of the Centers for Medicare & Medicaid Services includes both incentives for adopting and penalties for not adopting e-prescribing.

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Epi Continued….

Widespread pain that persists a year after a motor vehicle accident actually begins within weeks of the insult and should be treated as early as possible, researchers suggested here. About 10 percent of individuals injured in motor vehicle accidents suffer pain that -- instead of decreasing within the first 6 weeks after the incident -- develops into nonremitting pain that may increase, reported a research

team at the University of

North Carolina in Chapel Hill. The study identified 895

individuals injured in

motor vehicle accidents who presented at the emergency department and then were discharged home after evaluation. Of that group, 78 people had widespread pain at 1 year. The majority of individuals who were evaluated after the accident with widespread pain saw their pain reduced substantially at 6 weeks, and it was virtually nonexistent at 6 months. But in the other group, pain intensified in the 6 weeks after the accident, and then remained constant, still reaching intensity at 1 year that was similar to the pain felt immediately after the accident.

Treat Car Crash Pain Early On, Lest It Linger MedPage Today – May 5, 2014

Sports-Related Injuries Can Cause Isolated Renal Trauma Medscape – May 27, 2014

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College football players may experience changes in a brain area linked to memory even if they dodge impacts that result in concussion, a new study hints. The study, from the Laureate Institute for Brain Research, Tulsa, Oklahoma, found smaller bilateral hippocampal volume in college football players compared with healthy nonplayers. Players with a history of concussion also had

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dose. However, there were no differences in survival to discharge or neurological outcomes between any treatment groups or subgroups (initial cardiac rhythm, number of doses). The meta-analysis did not control for quality of cardiopulmonary resuscitation.

Cognitive Reserve Boosts Recovery After TBI Neurology – May 7, 2014

People with more years of education may be better able to recover from a traumatic brain injury, a new study suggests. The study from Johns Hopkins School of Medicine, Baltimore, Maryland, was published in the April 23 online issue of Neurology. The team found that individuals who attended education for 12 to 15 years (ie, those who had some postsecondary education) were almost 5 times more likely to recover without disability compared with those with less than 12 years' education (ie, those who didn't finish high school). And those with 16 or more years of education (ie, those who had at least an undergraduate degree) were 7 times more likely to recover without disability. Results showed that of the 769 patients included, disability-free recovery at 1 year after injury was achieved by 214 (27.8 percent). Patients with more years of education were more likely to recover without disability.

Football Tied to Brain Differences, Even Without Concussion Medscape – May 16, 2014

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smaller hippocampal volume than players without concussion. Further, the number of years playing football was inversely linked to both hippocampal volume and reaction time. The study included 25 players with a history of concussion, 25 college football players without a history of concussion, and 25 healthy controls who did not play football. Participants underwent high-resolution anatomic MRI to quantify brain volume and standardized tests of cognitive function. Their study joins several others showing brain differences in football players. For example, a study reported at the American Association of Neurological Surgeons meeting in April 2014, found that the more hits a football player's head takes during a season, the more white matter changes show up on diffusion tensor imaging of the player's brain, even in the absence of concussion.

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Boxers are not the only athletes who take blows to the kidneys; recreational athletes such as cyclists, skiers, and snowboarders can also sustain isolated high-grade renal trauma, investigators have found. Emergency

department clinicians and surgeons should be aware that patients who sustain a sports-related injury might have high-grade renal trauma in the

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AMERICAN TRAUMA SOCIETY - INFORM MAY 2014

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absence of injury to other organ systems according to researchers at the University of Utah School of Medicine in Salt Lake City. Researchers conducted a retrospective review of adult patients treated for renal trauma at the center from 2005 to 2011. Injuries were categorized as being related or unrelated to sports. Renal trauma sustained during a sporting activity but caused by a nonsport event, such as a bicyclist being struck by a car or a skier colliding with a snowmobile, was counted as a nonsport injury. The researchers identified 138 patients with a grade III to V injury on the American Association for the Surgery of Trauma (AAST) kidney injury scale; 42 were sports-related and 96 were not. Overall, men were more likely than women to sustain kidney injuries (61.1 vs 38.9). In particular, men were more likely to sustain sports-related injuries (90.5 vs 9.5), possibly because of their testosterone-fueled aggression and risk-taking activities. Sports injuries, in general, were less severe than nonsports injuries. Grade III injuries were more often sports injuries than nonsports injuries (57.9 percent vs 49.4 percent), as were grade IV injuries (39.5 percent vs 31.3 percent). However, grade V injuries were significantly less likely to be related to sports (2.6 percent vs 19.3 percent). In addition, mean injury severity score was lower for sports injuries than for nonsports injuries (12.6 vs 27.3), and sports-injured patients were more hemodynamically stable.

Renal Trauma Continued….

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Nearly one in five Medicare patients are victims of medical injuries that often aren't related to their underlying disease or condition, according to new

Childhood Trauma May Leave Its Mark In Blood Vessels Reuters Health – May 28, 2014 Young adults who were exposed to adverse experiences as children have greater signs of unhealthy blood vessel function than young people without a traumatic past, a new study finds. The results published online in Hypertension suggest that early-life stress may raise the risk of heart disease later on by affecting blood vessel function and blood pressure in ways that can be detected during young adulthood, the authors from the University of Alabama at Birmingham say. For their study, researchers analyzed data on 221 healthy adolescents and young adults recruited for a study of cardiovascular risk factors that started in 1989. The team looked at markers of blood vessel health including blood pressure, the heart's output of blood, characteristics of the pulse and levels of endothelin-1, a protein that constricts blood vessels and increases blood pressure. They calculated adverse childhood event (ACE) scores based on a questionnaire answered when the participants were about 21 years old. Those who reported one traumatic event were classified as having mild ACE and those with two or more traumatic events were classified as moderate or severe ACE. The researchers found that participants who had one traumatic event in childhood had plasma endothelin-1 levels that were an average of 18 percent higher than those who had reported no traumatic events, and those who had two or more traumatic childhood events had levels that were 24 percent higher.

1 in 5 Elderly Patients Injured by Medical Care WebMD – May 27, 2014

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research. The injuries included: being given the wrong medication, having an allergic reactionto a medication, or receiving any treatment that led to more complications of an existing medical problem. "These injuries are caused by the medical care or management rather than any underlying disease," said researchers from the Gerontology Program at Towson University in Maryland. About two-thirds of these injuries occurred during outpatient care, rather than in the hospital, the study findings showed. While there has been a great deal of effort in trying to understand medical injury in hospitals, not as much has been done in clinics, doctor's offices, outpatient surgery centers, emergency rooms and nursing homes. Findings from the study were published online May 27 in the journal Injury Prevention. Study authors collected data on more than 12,500 Medicare patients who made claims between 1998 and 2005. Their average age was 76. The researchers found that 19 percent of those included in the study experienced at least one adverse medical event. That's higher than previous research estimates that suggested the rate of adverse medical events was probably around 13.5 percent for hospitalized patients, according to background information in the study. Older people, men and those from lower-income backgrounds were most at risk of an adverse medical event. They also found that people who had chronic medical conditions or who were disabled in some way were more at risk of a medical injury. Each additional month of age was associated with a 1 percent increase in the risk of a medical injury. In addition, the risk of experiencing an adverse medical event increased by 27 percent for each chronic condition a person had, the report revealed. The death rate among those who had

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experienced a medical injury was nearly twice as high as among patients who hadn't had one.