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RCT Satellite Site Initiation Pre-Questionnaire

Potential Satellite Site Questionnaire

Thank you for expressing interest in participating in CWIS NON FLAIL. The goal of this questionnaire is to see if your institution would be a good fit for the trial. Please answer the following questions as accurately and truthfully as possible.
1.Please provide the following information.
2.What is your institutions's ACS Trauma Center designation ?
3.How many beds does your hospital have?
4.How many patients with rib fractures were admitted to your institution in the year 2016?
5.How many total Surgical Stabilization for Rib Fracture (SSRF) operations have been performed at your institution?
6.How many SSRF operations were performed at your institution in the 2016 calendar year?
7.How many surgeons currently perform SSRF at your institution?
8.Which specialties are currently performing SSRF at your institution? Please check all that apply.
9.What was the approximate median time from admission to SSRF at your institution (last 20 cases)?
10.What approximate percentage of patients in whom you perform SSRF do not have either radiographic or clinical flail chest?
11.Please indicate how frequently you use the following non-operative treatment modalities for your rib fracture patients.
Never
Selective
Routinely
Oral narcotics
Intra venous PRN narcotics (nursing pushes)
Intra venous PRN narcotics using patient controlled analgesia
Acetaminophen
Benzodiazepines
NSAIDS
Gabapentin
Ketamine
Rib blocks
Liposomal bupivicaine
Thoracic epidural cathers
Indwelling on-Q pain pumps
Kinesiology tape
12.Please indicate how frequently you use the following operative treatment modalities for your rib fracture patients.
Never
Selective
Routinely
Fiberoptic bronchoscopy
Pleural space irrigation and drainage
Single lung ventilation
Thoracoscopy
Muscle sparring approach
Supine positioning
Prone positioning
Liposomal bupivicaine rib blocks
Indwelling on-Q pain pumps
Bone grafting
Plates
Splints
Fixation to cartilidge
Chest tube
13.What are indications for rib fracture fixation at your institution?  Please check all that apply.