BACKGROUND: Induction of hypothermia (a 4 °C decrease from baseline) improves outcomes in adult cardiac arrest and neonatal hypoxic ischemic encephalopathy, and may benefit other conditions as well. Methods used to implement or prevent hypothermia typically require skin contact with blankets or pads or intravascular access with catheter devices. The study was to evaluate the potential to induce mild therapeutic hypothermia via an esophageal route in a porcine model.METHODS: Single-animal proof-of-concept study of a prototype esophageal device in a 70 kg Yorkshire swine. We measured the rate of temperature change after placement of a prototype device to induce hypothermia via the esophagus, and compared this rate to known temperature changes that occur under similar laboratory conditions without a hypothermic device.RESULTS: Swine temperature decreased from a starting temperature of 37.8 °C to 33.8 °C (achieving the goal of a 4 °C decrease) in 175 minutes, resulting in a cooling rate of 1.37 °C/h. Histopathology of the esophagus showed normal tissue without evidence of injury.CONCLUSION: A prototype of an esophageal cooling device induced hypothermia effectively in a large single-swine model.

BACKGROUND: Patients backlogged in the emergency department (ED) waiting for an inpatient bed (boarders) continue to require the attention of ED physicians, exacerbating crowding in the ED. To address this problem, we added a "fl oat shift" to our winter schedule solely to care for boarders. We sought to quantify the effect of this fl oat shift, hypothesizing greater physician productivity.METHODS: We performed a retrospective observational study in our community hospital ED, measuring the number of new patients seen in each 10-hour shift in the presence or absence of a fl oat shift physician. We calculated the number of new patients seen per shift for each of the 7 daily shifts, during February (fl oat shift scheduled) and May (fl oat shift unscheduled) of 2008. We then compared the mean number of patients seen per shift in February with May.RESULTS: Total monthly patient volume was 6656 for February and 6775 for May, with the mean daily census being 230 and 219 patients, respectively. The number of new patients seen during each shift was greater in February than in May, with a mean increase of 1.1 patients per shift (with the fl oat shift). Surveying participants about intervention effectiveness showed 92% of residents, but only 65% of attending physicians, in favor of maintaining the fl oat shift.CONCLUSION: The presence of a "fl oat shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED, despite the presence of longer throughput times and increased time on diversion.

OBJECTIVE: To analyze the trends in demographics and outcomes of patients presenting with traumatic brain injury by performing a retrospective database review of the Illinois Department of Public Health (IDPH) Trauma Registry.METHODS: We utilized the IDPH Trauma Registry to retrieve data on patients treated for traumatic brain injuries at our large, tertiary care hospital from 2004 to 2012, inclusive. From this data, logistic regression models were used to analyze and compare basic demographics such as age, sex, and clinical outcome.RESULTS: Three thousand and thirty-nine patients were analyzed with a mean age of 43 (standard deviation, 24) and a median age of 41 (interquartile range, 23 to 60). Over the study period, patients’ age increased steadily from 32 to 49 years. The percentage of female patients increased, from 16.4% to 27.5% over the last 4 years. Overall mortality was greater for males than females (22.1% vs. 17.3%; odds ratio [OR], 1.36; 95% confidence interval [CI], 1.10 to 1.68). Mortality decreased over the period (OR, 0.88; 95% CI, 0.85 to 0.91), with a greater decrease in females (OR, 0.84; 95% CI, 0.78 to 0.90) than in males (OR, 0.90; 95% CI, 0.86 to 0.94).CONCLUSION: Although the age of patients presenting with traumatic brain injury is increasing substantially, the data suggests that overall mortality appears to be decreasing, and this decrease appears to be greater in females than in males. These changes in trends found in the IDPH Trauma Registry supports the importance for further analysis of other reliable public datasets to identify areas of future study.
Brain Injuries ; Dataset ; Demography ; Emergency Service, Hospital ; Female ; Humans ; Illinois ; Logistic Models ; Male ; Mortality ; Odds Ratio ; Patient Outcome Assessment ; Public Health ; Retrospective Studies ; Tertiary Healthcare