Category Archives: General

Financial Impact Of Solid Organ Injury Management

The shift in management of adult solid organ injury from primarily operative to mostly nonoperative began in the late 1980s. For the last decade or so, we’ve been refining this management, figuring out failure criteria, the role of interventional radiology, and developing practice guidelines. We know we’ve been able to reduce the number of people that undergo operative management, with an acceptably low failure rate. But is there a financial impact as well?

Surgeons at the MedStar Hospital Center in Washington DC tapped into a huge hospital discharge database from 1994 to 2010. They focused on patients with admitting diagnoses of spleen or liver injury. They looked at relative costs compared to 1994 practice patterns (still quite a bit of operative management), hospital length of stay, and mortality risk.

Here are the factoids:

  • Nearly 30,000 spleen injury records and 15,000 liver injury records were reviewed
  • Nonop management of spleen injury increased from 38% to 67%, and for liver injury from 62% to 81%
  • In-hospital cost of care decreased by over $8,000 for each patient over the study period
  • Hospital length of stay decreased by about 2 days for each patient
  • Mortality in high risk patients dropped significantly (from 64% to 18% for liver, 30% to 20% for spleen)
  • Mortality in low risk patients remained unchanged (2-3%)

Bottom line: Yes, this study suffers from the usual pitfalls of massaging any large multi-institutional database. But what impresses me is that significant changes have been identified, despite huge variations in how nonoperative management is delivered at so many hospitals. As I have mentioned before, at my hospital we were able to show that just adhering to a standardized solid organ injury protocol squeezes yet another $1000 in costs out of each patient treated, on average. Time to adopt a protocol and adhere to it. Your hospital administrators will love you even more!

Related posts:

Reference: The impact of solid organ injury management on the US healthcare system. J Trauma 77(2):310-314, 2014.

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July Trauma MedEd Newsletter Released

The July newsletter is now available! Click the image below or the link at the bottom to download. This month’s topic is TBI.

In this issue you’ll find articles on:

  • Concussion testing apps
  • Diffuse axonal injury
  • (In)appropriate neurosurgical consultation
  • And more!

Subscribers received the newsletter first on Monday. If you want to subscribe (and download back issues), click here.

Click here to download and/or subscribe.

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Quick And Dirty Shoulder Exam

This is a short, 6 minute video that gives details on how to do a really good, quick exam to detect shoulder pathology. Jessie Nelson MD (Emergency Medicine) and Julie Switzer MD (Othorpedic Surgery) demonstrate. 

I have to put it a disclaimer for the disclaimer at the beginning of this video. It’s ridiculous, but my institution requires it. Sigh!

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Trauma Education: The Next Generation Coming Soon!

TE:TNG, version 2.0 is coming next month! Our fast-paced 4 hour program will be available live (but you have to come see me in St. Paul MN), or via LiveStream on Thursday, September 4.

Our guest speaker is Dr. Cliff Reid of the blog, live from Australia (via Skype), talking about “When ‘scoop and run’ is not an option: emergency medicine and trauma surgery outside the hospital.”

We also have a number of other live presenters, delivering 20 minute fact-packed talks on trauma topics applicable to all trauma professionals. Topics include:

  • Anticoagulation reversal
  • Complex dental trauma
  • Radiation exposure
  • Prehospital spine immobilization

Peppered among all the live presenters will be curbside consults, where we ask the specialists what you also wished you had asked. We’ll also show a variety of focused, 5 minute how-to videos on:

  • Lateral canthotomy
  • New drugs
  • Trauma team activation: the patient perspective
  • Eye emergencies

For more information, or to make arrangements to join us live or electronically, please visit our website at

I’m looking forward to “seeing” you there!


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July Trauma MedEd Newsletter Is Here!

The current newsletter is here! Subscribers will receive the next issue of the Trauma MedEd late tonight. The topic for the month is TBI.

Topics will include:

  • Apps for concussion testing
  • Field concussion testing for athletes
  • Diffuse axonal injury
  • Inappropriate neurosurgical consultation
  • And more!

To ensure you get it ASAP, click here to subscribe and download back issues. Non-subscribers will be able to download it this Friday.

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