ABSTRACTS VOORDRACHTEN WETENSCHAPSDAG SFG 2012 Is discharge of minimally injured trauma patients after primary and secondary survey justified? Vanessa Brown, MD LMM, Emergency Medicine, St. Franciscus Gasthuis, Rotterdam Bart Grimminck, MD, Ruwaard van Putten Ziekenhuis, Spijkenisse, Victor de Ridder, MD PhD MBA St. Franciscus Gasthuis, Rotterdam. INTRODUCTION: Dramatically increasing health care costs are pushing hospitals and insurance companies to emphasize outpatient management and to decrease length of hospitalization. We hypothesize that the minimally injured trauma patients, instead of admission or a period of observation, can be discharged after primary and secondary surveys at the emergency department. Tertiary survey can take place the next day at the emergency room or at the surgical outpatient clinic, done by either a physician or a trained nurse practitioner. METHODS: The institutional review board approved this study as a retrospective data collection study; as such informed consent was not required. The registry was queried for trauma patients undergoing 24-hour observation from January 2010 till December 2010 at the Sint Franciscus Hospital in Rotterdam, a level II trauma-hospital. For this purpose patients with a diagnose code (DBC code 294) were gathered and multi-trauma patients were excluded. Hospital admittance was defined as all trauma patients observed secondary to: mechanism of injury, lowered state of consciousness, need for further radiographic evaluation or social reasons. The admission records of all patients were reviewed in order to register missed injuries, which is defined as injury found during tertiary survey or during re-examination of radiographic interpretations. RESULTS: A total of 175 trauma patients were reviewed (table 1). Of these 116 were admitted to the hospital after primary and secondary survey (table 2). The most common reasons to admit a patient was for 24-hour observation, pain management and social reasons. The majority of patients, 99 of 116, were discharged after an observational period of 24 hours. Pain management and social reasons for elderly patients were the main reasons for prolonged hospitalization. Two patients were admitted to the intensive care for observational reasons. No missed injuries were found during tertiary survey in any of the patients. DISCUSSION: Our data suggest that in-hospital observation to detect missed injuries, after thorough primary and secondary survey at the emergency department, does not significantly alter detection of clinically relevant missed injuries. We suggest that minimally injured trauma patients should be discharged after primary and secondary surveys and that tertiary survey can take place the following day as an outpatient. This should only be done if radiologic examinations can be re-interpreted by a radiologist and a traumatologist/ traumasurgeon, as misdiagnosis of radiologic examination is till the biggest cause for missing injury in trauma patients. Outpatients could then still be treated adequately. Vitamine D deficiëntie is vaak geassocieerd met astma in morbide obese patiënten. Clara Shapiro-Koss1 , Astrid van huisstede2 , Gert-Jan Brauhnstahl2 1 afdeling interne geneeskunde, Sint Franciscus Gasthuis 2 Afdeling longgeneeskunde, Sint Franciscus Gasthuis 102 ACHTERGROND: Resultaten van recente publicaties wijzen op een verband tussen vitamine D deficiëntie en astma bij kinderen, waarbij een lage vitamine D spiegel een risicofactor is voor WETENSCHAPPELIJK jaarverslag 2012 Pagina 101
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