Tatsuya Norii

Heat-related emergencies are increasing in the United States (U.S.), but little is known about trends in prehospital heat-related encounters. This study examines temporal and geographic trends in prehospital heat-related encounters and assesses demographic and clinical factors associated with these heat-related encounters. We used an observational study design and a retrospective analysis of the 2019-2023 National Emergency Medical Services Information System (NEMSIS) databases. We described the characteristics of heat-related encounters and compared the rates of heat-related complaints by year. Comparing 2019 to each year from 2020-2023, we used logistic regression to evaluate the odds of heat-related complaints. We then repeated these regressions for each U.S. census division to evaluate for regional variation in the trends of heat-related complaints. We included 120,181,275 non-heat-related encounters and 478,666 heat-related encounters. Compared to non-heat-related encounters, heat-related encounters involved younger patients, more males, and higher rates of tachycardia and hypotension. The odds of heat-related encounters increased in 2023 compared to 2019 (odds ratio(OR) 1.04, (1.03-1.05)), but other years were similar. There was significant regional variation in heat-related encounters between Census Divisions, though. The largest increases were: 2020 - Mountain (OR 1.13 (1.09-1.16)); 2021 - Pacific (OR 1.25 (1.22-1.29)); 2022 - Mountain (OR 1.23 (1.19-1.26)) and West South Central (OR 1.19 (1.17-1.22)); 2023 - West South Central (OR 1.54 (1.51-1.57)) and West North Central (OR 1.18 (1.14-1.22)) and Mountain (OR 1.29 (1.25-1.33)). While national odds and proportions of heat-related prehospital encounters have risen slightly in 2023 compared to 2019, certain geographic regions have experienced far greater increases. Further research is needed to identify vulnerabilities and optimize emergency response strategies.

Frailty is a multidomain reduction in physiologic reserve that impacts recovery and can contribute to poor outcomes following trauma beyond what chronological age, comorbidities, or injury severity predicts. In geriatric trauma patients, a large proportion are frail or prefrail on initial encounter in the emergency department, and because there are opportunities for actionable management plans, major trauma guidelines endorse systematic screening integrated into coordinated geriatric trauma care. We reviewed the literature and identified practical instruments used in the acute trauma setting for risk stratification. Additionally, we highlight the feasibility of using these instruments, as some can be completed via patient report, proxy input, or chart review when cognition, language, or caregiver availability limits history-taking. Implementation efforts succeed when shared mental models are leveraged and screening is embedded in the electronic health record system, linked to order sets and trigger-based pathways that offer downstream goal-directed care management, such as early mobility, delirium prevention, nutrition, medication review, and comprehensive geriatric assessment. Additionally, we highlight the importance of initiating early goals-of-care discussions and coordinating care with palliative care services. Resource-limited systems can preserve the same architecture by using nurse-led or allied staff-led screening, tele-geriatric consultation, and virtual interdisciplinary huddles. Lastly, we expand upon opportunities for longitudinal post-discharge follow-up. We describe how targeted initiatives translate research into practice, improve outcomes, and support longitudinal reassessment through in-person and telehealth follow-up visits.

BACKGROUND AND OBJECTIVES: Type II odontoid fractures (T2OF) are the most prevalent cervical spine injuries among the elderly. Nonetheless, there are insufficient data regarding the influence of frailty on outcomes for both nonoperative and operative treatment approaches. We sought to evaluate the influence of frailty on outcomes using 5-factor modified frailty index. METHODS: We performed a retrospective review of the American College of Surgeons Trauma Quality Improvement Program database from 2015 to 2020. We analyzed nonoperative and operative traumatic T2OF cases. Outcomes included major complications, hospital length of stay (LOS), nonhome discharge (NHD), mortality rates, and survival probabilities. We used unmatched and propensity score–matched risk-adjusted models to assess the association between frailty and all outcomes. Survival probabilities were examined using Kaplan–Meier plots, stratified by frailty strata. RESULTS: A total of 22 440 patients comprising 7138 (31.8%) robust, 7913 (35.2%) normal, 5158 (22.9%) frail, and 2231 (9.9%) very frail patients were included. Results from unmatched multivariable analyses revealed a dose-dependent relationship between frailty and all outcomes, in both cohorts ( P < .05). Propensity score–matched resulted in 3942 nonoperative and operative matched pairs. Preoperative characteristics were similar between cohorts, except for age: 75 years (IQR: 60-83) for nonoperative and 70 years (IQR: 56-78) for operative, and male sex: 1799 (55.8%) for nonoperative and 439 (61.1%) for operative cohorts. Significant mortality reductions (43%-77%; P < .05) were observed in the operative cohort compared with the nonoperative cohort across all frailty strata. As expected, the operative cohort had longer LOS and increased NHD risk ranging from 64% to 97%, P < .001. In Kaplan–Meier analyses, survival declined significantly across increasing frailty strata P < .001. CONCLUSION: Increasing frailty was independently associated with major complications, LOS, NHD, and decreased survival. Operative patients exhibited improved survival compared with nonoperative patients across all frailty strata. These findings highlight the importance of frailty in T2OF management and care coordination.