Susan Dnp Cronn

Trauma research is an expansive discipline that informs injury prevention, best practices in care, and novel interventions. However, implicit bias, or the unconscious stereotypical beliefs about groups of people, can have profound implications for traumatic injury research. Several forms of implicit bias can emerge in trauma research, which deepens existing disparities based on race or ethnicity, sex, ability status, socioeconomic status, and other factors. This paper reviews how implicit bias affects the development of research and the application of findings, potentially leading to suboptimal care and misdirected preventive strategies in trauma. We present the recent dialogue and progress on implicit bias in research at the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) conference, an Agency for Healthcare Research and Quality-funded assembly of multiple disciplines which was convened to tackle the challenges involved in addressing disparities in traumatic injury. Through this review, we seek to generate momentum for action toward reducing implicit bias and establishing comprehensive equity-focused standards of trauma research and practice.

On August 2–3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) convened to discuss strategies to support research to eliminate disparities in trauma care. An ongoing challenge for performing high-quality equity-based research is the uncomfortable recognition that implicit bias and structural racism are deeply ingrained in our society and culture and are therefore often unrecognized in medicine and research practices. Throughout SAFER-Trauma, several examples of strategies to overcome these challenges were presented. In this article, we will relate a diverse array of examples through three distinct angles. The first focuses on innovations that harness existing data in novel and groundbreaking ways, uncovering fresh insights and applications from information already at our disposal. The second examines innovations that arise from traditional healthcare systems and research methods, showing how research in the healthcare sphere can adapt to meet modern needs. The third will explore projects that emerged from communities, driven by the pressing needs and aspirations of the people they serve.

Background This project analyzed risk factors for emergency department (ED) utilization without readmission within 2 weeks post-discharge for survivors of gun violence. Methods A hundred gun violence survivors admitted to a Level 1 trauma center were surveyed. Descriptive analyses and group comparisons were conducted between patients who did and did not use the ED. Factors analyzed are rooted in social determinants of health and clinical care related to the index hospitalization. Results Of the 100 patients, 31 had an ED visit within 6 weeks, although most (87.1%) returned within 2 weeks of discharge. Factors significantly associated (p≤0.05) with a return ED visit included: not having an identified primary care provider, not having friends or family to count on for help, not having enough money to support themselves before return to work, and not feeling able to read discharge instructions. Conclusion Lack of a primary care provider, low health literacy and social support were associated with increased ED visits without readmission post-discharge. Level of Evidence Level III, Prognostic and Epidemiological

BACKGROUND: Persons of low socioeconomic status are overrepresented in the firearm injury patient population and may experience challenges in accessing complex outpatient health systems. Consequently, outpatient care for these patients is plagued by poor follow-up and increased emergency department (ED) utilization. We developed a Post Discharge Care Team (PDCT) consisting of a dedicated trauma nurse navigator and medical social worker to bridge the gap between hospital discharge and outpatient care to improve recovery. METHODS: Adult firearm injury survivors admitted to the trauma service were randomized 1:1 to receive either PDCT services or standard of care (SOC) workflows. The PDCT nurse provided education and set expectations regarding injuries, wound care, and outpatient follow-up. The PDCT social worker performed a comprehensive assessment to identify concerns including housing and financial instability, food insecurity, or transportation issues. The primary outcome was ED utilization, with secondary outcomes including readmissions and overall health care costs compared between groups. RESULTS: In the first 6 months of the study, a total of 44 patients were randomized to PDCT and 47 to SOC. There were 10 patients who visited the ED in the PDCT group compared with 16 in the SOC group (p = 0.23) for a total of 14 and 23 ED visits, respectively. There were 14 patients in the PDCT and 11 patients in the SOC groups who were readmitted (p = 0.31), but the PDCT group was readmitted for 27.9 fewer hospital days. After accounting for programmatic costs, the PDCT had a hospital savings of $34,542.71. CONCLUSION: A collaborative, specialized PDCT for firearm injury survivors consisting of a dedicated trauma nurse navigator and medical social worker decreased outpatient ED utilization, readmission days, and was cost effective. Trauma centers with high volumes of penetrating trauma should consider a similar model to improve outpatient care for firearm injury survivors. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

Objective: Multiple studies evaluate relative risk of female vs. male crash injury; clinical data may offer a more direct injury-specific evaluation of sex disparity in vehicle safety. This study sought to evaluate trauma injury patterns in a large trauma database to identify sex-related differences in crash injury victims.Methods: Data on lap and shoulder belt wearing patients age 16 and up with abdominal and pelvic injuries from 2018 to 2021 were extracted from the National Trauma Data Bank for descriptive analysis using injuries, vital signs, International Classification of Disease (ICD) coding, age, and injury severity using AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score). Multiple linear regression was used to assess the relationship of shock index (SI) and ISS, sex, age, and sex^*age interaction. Regression analysis was performed on multiple injury regions to assess patient characteristics related to increased shock index.Results: Sex, age, and ISS are strongly related to shock index for most injury regions. Women had greater overall SI than men, even in less severe injuries; women had greater numbers of pelvis and liver injuries across severity categories; men had greater numbers of injury in other abdominal/pelvis injury regions.Conclusions: Female crash injury victims' tendency for higher (AIS) severity of pelvis and liver injuries may relate to how their bodies interact with safety equipment. Females are entering shock states (SI > 1.0) with lesser injury severity (ISS) than male crash injury victims, which may suggest that female crash patients are somehow more susceptible to compromised hemodynamics than males. These findings indicate an urgent need to conduct vehicle crash injury research within a sex-equity framework; evaluating sex-related clinical data may hold the key to reducing disparities in vehicle crash injury.

BACKGROUND: Trauma registries exist to provide data for evaluating the quality of care of trauma patients. These data facilitate research and can be used for outreach, planning, and improvement in trauma patient outcomes. However, the accuracy of registry data related to suicide has not been well studied. OBJECTIVE: This study sought to evaluate the accuracy of current trauma registry coding practices related to labeling injury as a suicide attempt among patients presenting to a Level I trauma center after self-inflicted injury. METHODS: We conducted a single-center, retrospective cohort analysis of a Level I trauma center trauma registry on all patients with self-inflicted injuries from 2011 to 2021. Manual chart review was used to identify cases wherein patients' injuries were categorized as suicidal despite the absence of suicidal intent. RESULTS: During this 11-year period, 537 patients were identified as having presented to the trauma center for traumatic self-inflicted injuries. Manual chart review revealed that 16% of these patients were incorrectly categorized as having attempted suicide despite their self-inflicted injury lacking suicidal intent (e.g., accidents, nonsuicidal self-harm). CONCLUSION: We found that 16% of trauma registry patients were overcategorized as having attempted suicide. Trauma registry data are an important source of information for activities related to injury prevention in trauma centers. Imprecise coding of self-inflicted injury may lead to poorly targeted programs and interventions due to incorrectly represented injury causes and patterns in trauma patient populations, including suicide prevention.

Background/purpose This 8-year retrospective study of the National Trauma Data Bank describes temporal trends of traumatic injury by mechanism of injury (MOI) by demographic characteristics from 2012 to 2019 for adult patients 18 years and older. Methods Overall, 5 630 461 records were included after excluding those with missing demographic information and International Classification of Disease codes. MOIs were calculated as proportions of total injury by year. Temporal trends of MOI were evaluated using two-sided non-parametric Mann-Kendall trend tests for (1) all patients and (2) within racial and ethnic groups (ie, Asian, 2% of total patient sample; Black, 14%; Hispanic or Latino, 10%; Multiracial, 3%; Native American, Results/outcomes For all patients, falls increased over time (p=0.001), whereas burn (pConclusions These results suggest that falls are an important injury prevention target with an ageing US population across all racial and ethnic groups. Differing injury profiles by racial and ethnic identity indicate that injury prevention efforts be designed accordingly and targeted specifically to individuals most at risk for specific MOIs. Study type Level I, prognostic/epidemiological.

Background: Inconsistent and nonstandardized patient handoffs can increase the risk of adverse events. Using change theory may promote adoption of effective handoff processes. Local Problem: A Midwest emergency department (ED) had no standardized practice for shift change handoffs. Previous handoff quality improvement efforts had been unsuccessful. Methods: A pre/postintervention pilot project design was used. Nurses' compliance with the new handoff protocol was evaluated. Interventions: Using Diffusion of Innovation (DOI) theory, an evidence-based shift change protocol was designed and implemented, which included a comprehensive handoff tool specific to the ED. Results: Four elements in the new shift change process saw statistically significant improvements after implementation, including discussion of the patient's illness severity (P = .001), synthesis of the patient's care (P < .001), completing a bedside safety checklist (P < .001), and providing a formal transition-of-care process (P < .001). Conclusions: Using DOI theory may improve the adoption of new shift change practices.