Prospective evaluation of an ED observation unit protocol for trauma activation patients

• Published in: The American journal of emergency medicine Vol. 30; no. 8; pp. 1402 - 1406
• Main Authors: Holly, Jessica, MD, Bledsoe, Joseph, MD, Black, Kathryn, Robbins, Riann, Davis, Virgil, MD, Bossart, Philip, MD, Barton, Erik, MD, MS, MBA, Madsen, Troy, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier; Elsevier Limited
• Subjects: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical Protocols; Cost control; Emergency; Emergency medical care; Emergency medical services; Emergency services; Female; Hospitalization; Hospitals; Humans; Injuries; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Metabolic disorders; Middle Aged; Observational studies; Pain; Patient Discharge; Patient satisfaction; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Raises; Respiratory system; Studies; Trauma Centers; Wounds and Injuries - therapy; Young Adult; United States > US; Utah; Human; Intensive care; Trauma; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2011.10.012

Abstract Background The University of Utah emergency department (ED) observation unit (EDOU) cares for over 2500 patients each year, with a significant portion of these patients being trauma activation patients. We evaluated the safety and efficacy of our EDOU trauma protocol and described patient characteristics and outcomes of trauma patients managed in an EDOU. Methods We performed a prospective observational study of all trauma patients admitted to the EDOU over a 1-year period. Patient disposition, interventions, and adverse events during observation were recorded. Thirty-day follow-up was performed by telephone and chart review to evaluate for missed injuries, repeat hospitalizations, or repeat traumatic events. Results A total of 259 trauma patients were admitted to the EDOU during the study period and were contacted at least 30 days after discharge. There were no deaths, intubations, or other adverse events. At 30-day follow-up, there was 1 missed injury, which did not result in an adverse outcome. Ten patients were reevaluated in the ED or required hospitalization for events occurring after their initial EDOU stay but related to their initial trauma evaluation. The inpatient admission rate from the EDOU was 10.4%, and 3.1% of patients reported another traumatic event during the 30-day follow-up period. Conclusions There were no adverse outcomes in trauma patients admitted to the EDOU, and our inpatient admission rate was within the generally accepted admission rate for patients in observation status. The EDOU appears to be a safe alternative to inpatient admission for the evaluation of minimally injured trauma activation patients.