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Bath MF, Hobbs L, Kohler K, Kuhn I, Nabulyato W, Kwizera A, Walker LE, Wilkins T, Stubbs D, Burnstein RM, Kolias A, Hutchinson PJ, Clarkson PJ, Halimah S, Bashford T. Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review. Emerg Med J 2024; 41:409-414. [PMID: 38388191 PMCID: PMC11228185 DOI: 10.1136/emermed-2023-213782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity. METHODS We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review. RESULTS Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes. DISCUSSION There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings. PROSPERO REGISTRATION NUMBER CRD42022348529 LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Michael F Bath
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Laura Hobbs
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Katharina Kohler
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, University of Cambridge, Cambridge, UK
| | - William Nabulyato
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
| | - Arthur Kwizera
- Department of Anaesthesia and Intensive Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Laura E Walker
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tom Wilkins
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Daniel Stubbs
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - R M Burnstein
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Peter John Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - P John Clarkson
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - Sara Halimah
- Trauma Operational Advisory Team, World Health Organization, Cairo, Egypt
| | - Tom Bashford
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
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Hardy BM, King KL, Enninghorst N, Balogh ZJ. Trends in polytrauma incidence among major trauma admissions. Eur J Trauma Emerg Surg 2024; 50:623-626. [PMID: 36536173 PMCID: PMC11249606 DOI: 10.1007/s00068-022-02200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Polytrauma is increasingly recognized as a disease beyond anatomical injuries. Due to population growth, centralization, and slow uptake of preventive measures, major trauma presentations in most trauma systems show a slow but steady increase. The proportional contribution of polytrauma patients to this increase is unknown. METHODS A 13-year retrospective analysis ending 31/12/2021 of all major trauma admissions (ISS > 15) to a level-1 trauma center were included. Polytrauma was classified using the Newcastle definition. Linear regression analysis was used to compare the rates of patient presentation over time. Logistic regression was used to measure for change in proportion of polytrauma. Data are presented as median (IQR), with odds ratios and 95% confidence intervals as appropriate. RESULTS 5897 (age: 49 ± 43 years, sex: 71.3% male, ISS: 20 ± 9, mortality: 10.7%) major trauma presentations were included, 1,616 (27%) were polytrauma (age: 45 ± 37 years, 72.0% male, ISS: 29 ± 14, mortality: 12.7%). Major trauma presentations increased significantly over the study period (+ 8 patients per year (3-14), p < 0.01), aged significantly (0.42 years/year (0.25-0.59, p < 0.001). The number of polytrauma presentations per year did not change significantly (+ 1 patients/year (- 1 to 4, p > 0.2). Overall unadjusted mortality did not change (OR 0.99 (0.97-1.02). Polytrauma mortality fell significantly (OR 0.96 (0.92-0.99)) over the study period. CONCLUSIONS Polytrauma patients represent about 25% of the major trauma admissions, with higher injury severity, static incidence and higher but improving mortality in comparison to all major trauma patients. Separate reporting and focused research on this group are warranted as monitoring the entire major trauma cohort does not identify these specifics of this high acuity subgroup.
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Affiliation(s)
- Benjamin Maurice Hardy
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW, 2310, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Kate Louise King
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW, 2310, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | | | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW, 2310, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
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McIver R, Erdogan M, Parker R, Evans A, Green R, Gomez D, Johnston T. Effect of trauma quality improvement initiatives on outcomes and costs at community hospitals: A scoping review. Injury 2024; 55:111492. [PMID: 38531721 DOI: 10.1016/j.injury.2024.111492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Due to complex geography and resource constraints, trauma patients are often initially transported to community or rural facilities rather than a larger Level I or II trauma center. The objective of this scoping review was to synthesize evidence on interventions that improved the quality of trauma care and/or reduced healthcare costs at non-Level I or II facilities. METHODS A scoping review was performed to identify studies implementing a Quality Improvement (QI) initiative at a non-major trauma center (i.e., non-Level I or II trauma center [or equivalent]). We searched 3 electronic databases (MEDLINE, Embase, CINAHL) and the grey literature (relevant networks, organizations/associations). Methodological quality was evaluated using NIH and JBI study quality assessment tools. Studies were included if they evaluated the effect of implementing a trauma care QI initiative on one or more of the following: 1) trauma outcomes (mortality, morbidity); 2) system outcomes (e.g., length of stay [LOS], transfer times, provider factors); 3) provider knowledge or perception; or 4) healthcare costs. Pediatric trauma, pre-hospital and tele-trauma specific studies were excluded. RESULTS Of 1046 data sources screened, 36 were included for full review (29 journal articles, 7 abstracts/posters without full text). Educational initiatives including the Rural Trauma Team Development Course and the Advanced Trauma Life Support course were the most common QI interventions investigated. Study outcomes included process metrics such as transfer time to tertiary care and hospital LOS, along with measures of provider perception and knowledge. Improvement in mortality was reported in a single study evaluating the impact of establishing a dedicated trauma service at a community hospital. CONCLUSIONS Our review captured a broad spectrum of trauma QI projects implemented at non-major trauma centers. Educational interventions did result in process outcome improvements and high rates of self-reported improvements in trauma care. Given the heterogeneous capabilities of community and rural hospitals, there is no panacea for trauma QI at these facilities. Future research should focus on patient outcomes like mortality and morbidity, and locally relevant initiatives.
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Affiliation(s)
- Reba McIver
- Dalhousie University, School of Medicine, Halifax, NS, Canada.
| | - Mete Erdogan
- Nova Scotia Health Trauma Program, Halifax, NS, Canada
| | - Robin Parker
- Dalhousie University Libraries, Halifax, NS, Canada
| | - Allyson Evans
- Dalhousie University, School of Medicine, Halifax, NS, Canada
| | - Robert Green
- Nova Scotia Health Trauma Program, Halifax, NS, Canada; Dalhousie University, Faculty of Medicine, Department of Emergency Medicine, Halifax, NS, Canada; Dalhousie University, Faculty of Medicine, Department of Critical Care, Halifax, NS, Canada
| | - David Gomez
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Tyler Johnston
- Dalhousie University, Faculty of Medicine, Department of Emergency Medicine, Halifax, NS, Canada
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Baker JB, Keenan S, Duquette-Frame TA, Kotwal R, Harvey AS, Cap AP, Shackelford SA, Gurney JM. Analysis of the U.S. Military Trauma System in Accordance With Doctrinal Levels of Warfare. Mil Med 2024; 189:1098-1105. [PMID: 36840463 DOI: 10.1093/milmed/usad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION In recent conflicts, the Joint Theater Trauma System (JTTS) led the systematic approach to improve battlefield trauma care, substantially contributing to the unprecedented survival of combat casualties. The Joint Trauma System (JTS) was codified in 2016 to preserve the lessons learned and functions of the JTTS, including the Department of Defense Trauma Registry. Concurrently, Combatant Commands (CCMD) were directed to establish CCMD Trauma Systems (CTS) "modeled after the JTTS" and to maintain a baseline of core functions intended to rapidly scale as needed. The complex nature of both CCMDs and the military trauma system has challenged the full implementation of the CTS. Analyzing the historical experiences of the JTTS, JTS, and CTS within a military doctrinal framework might enable the further success of the military trauma system. METHODS The strategic, operational, and tactical levels of warfare, in accordance with Joint Publication 1-0, Doctrine of the Armed Forces of the United States, and Joint Publication 3-0, Joint Operations, established the analytic framework for this study. The literature regarding the JTTS, CTS, and JTS was reviewed for relevant information concerning organizational structure and functions of trauma system performance improvement (PI) capabilities. A comprehensive analysis was performed using a thematic approach to evaluating descriptive data contained within the collected data set. Deployed trauma system PI tasks, functions, and responsibilities were identified, defined, and correlated according to the respective levels of warfare. RESULTS The comprehensive analysis revealed both discrete and overlapping tasks, functions, and responsibilities of the trauma system PI capabilities at each of the three levels of warfare. Strategic-level actions were categorized according to 12 distinct themes: reduce mortality; strategic reporting; centralized trauma registry; strategic communications; centralized organization; direct support to CCMDs; Department of Defense policy and doctrine; strategic-level PI; clinical practice guidelines; training and readiness standards; force structure, standardization, and interoperability; and research and development. Operational-level actions were categorized according to seven distinct themes: theater trauma system policies and requirements; theater trauma system leadership; stakeholder coordination; theater communication; theater standards for readiness and skill sustainment; trauma system planning; and medical logistics support. Tactical-level actions were categorized according to seven distinct themes: trauma system personnel; PI; documentation enforcement and patient care data collection; tactical planning recommendations for employing medical assets; research support; communication and reporting; and training and skills sustainment. CONCLUSION The deployed U.S. military trauma system requires a robust PI capability to optimize combat casualty care. Policy updates, a joint military trauma system doctrine, and force design updates are necessary for deployed military trauma system PI capabilities to function optimally across all levels of warfare.
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Affiliation(s)
- Jay B Baker
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX 78234, USA
| | - Sean Keenan
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX 78234, USA
| | | | - Russ Kotwal
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX 78234, USA
| | - Andrew S Harvey
- Department of Distance Education, Command and General Staff School, Fort Leavenworth, KS 66027, USA
| | - Andrew P Cap
- Institute of Surgical Research, Defense Health Agency, JBSA Fort Sam Houston, TX 78209, USA
| | - Stacy A Shackelford
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX 78234, USA
| | - Jennifer M Gurney
- Joint Trauma System, Defense Health Agency, JBSA Fort Sam Houston, TX 78234, USA
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Gauss T, de Jongh M, Maegele M, Cole E, Bouzat P. Trauma systems in high socioeconomic index countries in 2050. Crit Care 2024; 28:84. [PMID: 38493142 PMCID: PMC10943799 DOI: 10.1186/s13054-024-04863-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.
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Affiliation(s)
- Tobias Gauss
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France.
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France.
| | - Mariska de Jongh
- Network Emergency Care Brabant (NAZB), ETZ Hospital, Tilburg, The Netherlands
| | - Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University Witten-Herdecke, Cologne, Germany
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Pierre Bouzat
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France
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Schoenfeld D, Thomas CE, McCartin MP, Blumen IJ, Galvagno SM, Thomas SH. Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022. Air Med J 2024; 43:124-132. [PMID: 38490775 DOI: 10.1016/j.amj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) is widely used for prehospital and interfacility transport, but there is a paucity of HEMS outcomes data from studies using randomized controlled trial designs. In the absence of robust randomized controlled trial evidence, judgments regarding HEMS potential benefit must be informed by observational data. Within the study design set of observational analyses, the natural experiment (NE) is notable for its high potential methodologic quality; NE designs are occasionally denoted "quasi-experimental." The aim of this study is to examine all NE outcomes studies in the HEMS literature and to discern what lessons can be learned from these potentially high-quality observational data. METHODS HEMS NE studies were identified during the development of a new HEMS Outcomes Assessment Research Database (HOARD). HOARD was constructed using a broad-ranging search of published and gray literature resources (eg, PubMed, Embase, and Google Scholar) that used variations of the terms "helicopter EMS," "air ambulance," and "air medical transport." Among the 221 studies ultimately included in HOARD, 16 NE publications describing 13 sets of observational data comprising myriad diagnostic groups were identified. Of these 16 HEMS NEs, 4 HEMS NE studies assessing trauma outcomes were used in a meta-analysis. A meta-analysis was also performed of 4 HEMS NE studies. RESULTS Although the disparity of studies (in terms of both case mix and end points) precluded the generation of a pooled effect estimate of an adjusted mortality benefit of HEMs versus ground emergency medical services, HEMS was found to be associated with outcomes improvement in 8 of the 13 cohorts. CONCLUSION The weight of the NE evidence supports a conclusion of some form of HEMS-mediated outcomes improvement in a variety of patient types. Meta-analysis of 4 HEMS NE studies assessing trauma outcomes generated a model with acceptable heterogeneity (I2 = 43%, Q test: P = .16), which significantly (P < .01) favored HEMS use with a pooled HEMS survival odd ratio estimate of 1.66 (95% confidence interval, 1.23-2.22).
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Affiliation(s)
- David Schoenfeld
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Caroline E Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Michael P McCartin
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL.
| | - Ira J Blumen
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; EMS Division, Department of Emergency Medicine, Harvard Medical School, Boston, MA; Barts & The London School of Medicine, Queen Mary University of London, London, UK
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El-Qawaqzeh K, Magnotti LJ, Hosseinpour H, Nelson A, Spencer AL, Anand T, Bhogadi SK, Alizai Q, Ditillo M, Joseph B. Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes? Injury 2024; 55:110972. [PMID: 37573210 DOI: 10.1016/j.injury.2023.110972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/09/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION It remains unclear whether geriatrics benefit from care at higher-level trauma centers (TCs). We aimed to assess the impact of the TC verification level on frail geriatric trauma patients' outcomes. We hypothesized that frail patients cared for at higher-level TCs would have improved outcomes. STUDY DESIGN Patients ≥65 years were identified from the Trauma Quality Improvement Program (TQIP) database (2017-2019). Patients transferred, discharged from emergency department (ED), and those with head abbreviated injury scale >3 were excluded. 11-factor modified frailty index was utilized. Propensity score matching (1:1) was performed. Outcomes included discharge to skilled nursing facility or rehab (SNF/rehab), withdrawal of life-supporting treatment (WLST), mortality, complications, failure-to-rescue, intensive care unit (ICU) admission, hospital length of stay (LOS), and ventilator days. RESULTS 110,680 patients were matched (Frail:55,340, Non-Frail:55,340). Mean age was 79 (7), 90% presented following falls, and median ISS was 5 [2-9]. Level-I/II TCs had lower rates of discharge to SNF/rehab (52.6% vs. 55.8% vs. 60.9%; p < 0.001), failure-to-rescue (0.5% vs. 0.4% vs. 0.6%;p = 0.005), and higher rates of WLST (2.4% vs. 2.1% vs. 0.3%; p < 0.001) compared to level-III regardless of injury severity and frailty. Compared to Level-III centers, Level-I/II centers had higher complications among moderate-to-severely injured patients (4.1% vs. 3.3% vs. 2.7%; p < 0.001), and lower mortality only among frail patients regardless of injury severity (1.8% vs. 1.5% vs. 2.6%; p < 0.001). Patients at Level-I TCs were more likely to be admitted to ICU, and had longer hospital LOS and ventilator days compared to Level-II and III TCs (p < 0.05). CONCLUSION Frailty may play an important role when triaging geriatric trauma patients. In fact, the benefit of care at higher-level TCs is particularly evident for patients who are frail. Level III centers may be underperforming in providing access to palliative and end-of-life care.
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Affiliation(s)
- Khaled El-Qawaqzeh
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Adam Nelson
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Qaidar Alizai
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA.
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Lapidus O, Rubenson Wahlin R, Bäckström D. Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals. Scand J Trauma Resusc Emerg Med 2023; 31:101. [PMID: 38104083 PMCID: PMC10725597 DOI: 10.1186/s13049-023-01168-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear. AIM To investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS. METHODS A total of 74,032 trauma patients treated during 2012-2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation. RESULTS 4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9-15), 5.4% vs 9.4% (ISS 16-24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups. CONCLUSION Trauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.
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Affiliation(s)
- Oscar Lapidus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden
- Ambulance Medical Service in Stockholm (AISAB), Stockholm, Sweden
| | - Denise Bäckström
- Division of Surgery, Orthopedics and Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- VO Ambulans Och Akut, Region Gävleborg, Sweden
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Rudman JS, Fritz CL, Thomas SA, McCartin M, Price J, Blumen IJ, Thomas SH. Helicopter Emergency Medical Services Outcomes Research 1983 to 2022: Evidence Overview and Longitudinal Trends. Air Med J 2023; 42:429-435. [PMID: 37996177 DOI: 10.1016/j.amj.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) literature has been assessed in reviews focusing on various diagnoses, but there are few, if any, summaries of the entire body of HEMS outcomes evidence. Our goal was to summarize the existing research addressing patient-centered outcomes potentially accrued with HEMS. METHODS As part of the Critical Care Transport Collaborative Outcomes Research Effort, we generated the HEMS Outcomes Assessment Research Database and executed descriptive analyses of longitudinal trends from 1983 to 2022. Both indexed and gray literature sources were incorporated in the HEMS Outcomes Assessment Research Database. Studies were reviewed by at least 2 authors to select those that addressed a patient-centered outcome. Studies addressing solely HEMS logistics were excluded. Categoric analyses were executed with the Fisher exact test, and continuous variables were evaluated for normality with normal quantile plotting and a comparison of medians and 95% confidence intervals. RESULTS We found that HEMS outcomes study sample sizes increased steadily from 1983 to 2012, with the most recent decade demonstrating a marked increase in the rate of publication of HEMS outcomes studies. Most research (70.6%) addressed trauma patient outcomes, but recent decades have seen a significant increase in non-trauma studies. Recent decades have also been characterized by an increase in the production of HEMS outcomes research outside of North America and Europe. CONCLUSION This study summarizes the current state of the HEMS outcome literature. We highlight increasing contributions from worldwide researchers and increasing focus on HEMS benefits in non-trauma cases, particularly time-critical cases such as cardiac or stroke diagnoses. This provides a basis for further investigations into patient-oriented benefits potentially accrued with HEMS.
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Affiliation(s)
- Jordan S Rudman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Christie L Fritz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sarah A Thomas
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael McCartin
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - James Price
- Department of Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, United Kingdom
| | - Ira J Blumen
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
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10
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Gohy B, Opava CH, von Schreeb J, Van den Bergh R, Brus A, Fouda Mbarga N, Ouamba JP, Mafuko JM, Mulombwe Musambi I, Rougeon D, Côté Grenier E, Gaspar Fernandes L, Van Hulse J, Weerts E, Brodin N. Assessing independence in mobility activities in trauma care: Validity and reliability of the Activity Independence Measure-Trauma (AIM-T) in humanitarian settings. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001723. [PMID: 37695762 PMCID: PMC10495016 DOI: 10.1371/journal.pgph.0001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
The importance of measuring outcomes after injury beyond mortality and morbidity is increasingly recognized, though underreported in humanitarian settings. To address shortcomings of existing outcome measures in humanitarian settings, the Activity Independence Measure-Trauma (AIM-T) was developed, and is structured in three subscales (i.e., core, lower limb, and upper limb). This study aimed to assess the AIM-T construct validity (structural validity and hypothesis testing) and reliability (internal consistency, inter-rater reliability and measurement error) in four humanitarian settings (Burundi, Iraq, Cameroon and Central African Republic). Patients with acute injury (n = 195) were assessed using the AIM-T, the Barthel Index (BI), and two pain scores. Structural validity was assessed through confirmatory factor analysis. Hypotheses were tested regarding correlations with BI and pain scores using Pearson correlation coefficient (PCC) and differences in AIM-T scores between patients' subgroups, using standardized effect size Cohen's d (d). Internal consistency was assessed with Cronbach's alpha (α). AIM-T was reassessed by a second rater in 77 participants to test inter-rater reliability using intraclass correlation coefficient (ICC). The results showed that the AIM-T structure in three subscales had an acceptable fit. The AIM-T showed an inverse weak to moderate correlation with both pain scores (PCC<0.7, p≤0.05), positive strong correlation with BI (PCC≥0.7, p≤0.05), and differed between all subgroups (d≥0.5, p≤0.05). The inter-rater reliability in the (sub)scales was good to excellent (ICC 0.86-0.91) and the three subscales' internal consistency was adequate (α≥0.7). In conclusion, this study supports the AIM-T validity in measuring independence in mobility activities and its reliability in humanitarian settings, as well as it informs on its interpretability. Thus, the AIM-T could be a valuable measure to assess outcomes after injury in humanitarian settings.
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Affiliation(s)
- Bérangère Gohy
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Humanity & Inclusion, Rehabilitation Technical Direction, Brussels, Belgium
| | - Christina H. Opava
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm Sweden
| | | | - Aude Brus
- Humanity & Inclusion, Innovation, Impact & Information Division, Brussels, Belgium
| | - Nicole Fouda Mbarga
- Médecins Sans Frontières, Operational Center Geneva, YaoundeYaounde, Cameroon
| | - Jean Patrick Ouamba
- Médecins Sans Frontières, Operational Center Geneva, YaoundeYaounde, Cameroon
| | - Jean-Marie Mafuko
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
| | - Irene Mulombwe Musambi
- Médecins Sans Frontières, Operational Center Paris, Bangui, Central African Republic, Baghdad, Iraq
| | - Delphine Rougeon
- Médecins Sans Frontières, Operational Center Paris, Bangui, Central African Republic, Baghdad, Iraq
| | | | | | | | - Eric Weerts
- Humanity & Inclusion, Rehabilitation Technical Direction, Brussels, Belgium
| | - The AIM-T Study Group
- Médecins Sans Frontières, Operational Center Brussels, Brussels, Belgium
- Médecins Sans Frontières, Operational Center Geneva, YaoundeYaounde, Cameroon
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
- Médecins Sans Frontières, Operational Center Paris, Bangui, Central African Republic, Baghdad, Iraq
- Médecins Sans Frontières, Operational Center Paris, Baghdad, Iraq
- Médecins Sans Frontières, Operational Center Paris, France
| | - Nina Brodin
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd Hospital Corp., Division of Physiotherapy, Danderyd, Sweden
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11
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Dinh M, Singh H, Deans C, Pople G, Sarrami P, Sisson G, Newman J, Bendall J. Evaluation of the New South Wales ambulance T1 major trauma transport protocol: A state-wide data linkage study. Injury 2023; 54:110846. [PMID: 37246112 DOI: 10.1016/j.injury.2023.110846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Prehospital triage and transport protocols are critical components of the trauma systems. Still, there have been limited studies evaluating the performance of trauma protocols in New South Wales, such as the NSW ambulance major Trauma transport protocol (T1). OBJECTIVES Determine the performance of a major trauma transport protocol in a cohort of ambulance road transports METHODS: A data-linkage study using routine ambulance and hospital datasets across New South Wales Australia. Adult patients (age > 16 years) where any trauma protocol was indicated by paramedic crews and transported to any emergency department in the state were included. Major injury outcome was defined as an Injury Severity Score >8 based on coded in-patient diagnoses, or admission to intensive care unit or death within 30 days due to injury. Multivariable logistic regression was used to determine ambulance predictors of major injury outcome. RESULTS There were 168,452 linked ambulance transports analysed. Of the 9,012 T1 protocol activations, 2,443 cases had major injury [positive predictive value (PPV) = 27.1%]. There were 16,823 major injuries in total giving a sensitivity of the T1 protocol of 2,443/16,823 (14.5%), specificity of 145,060/151,629 (95.7%) and a negative predictive value (NPV) of 145,060/159,440 (91%). Overtriage rate associated with T1 protocol was 5,697/9,012 (63.2%) and undertriage rate was 5,509/159,440 (3.5%). The most important predictor of major injury was the activation of more than one trauma protocol by ambulance paramedics. DISCUSSION Overall, the T1 was associated with low undertriage and high specificity. The protocol may be improved by considering age and the number of trauma protocols activated by paramedics for any given patient.
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Affiliation(s)
- Michael Dinh
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia; Sydney Medical School, the University of Sydney, Australia
| | - Hardeep Singh
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia
| | | | | | - Pooria Sarrami
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia; South Western Sydney Clinical School, University of New South Wales, Australia.
| | - Glenn Sisson
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia
| | - Jonathon Newman
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia
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Fischer J, Barbois S, Quesada JL, Boddaert G, Haen P, Bertani A, Duhamel P, Delmas JM, Lechevallier E, Piolat C, Rongieras F, Tresallet C, Balandraud P, Arvieux C. Early Evaluation of a New French Surgery Course in the Best Practice of Dealing With Major Incidents and Mass Casualty Events. JOURNAL OF SURGICAL EDUCATION 2023; 80:1253-1267. [PMID: 37429782 DOI: 10.1016/j.jsurg.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The main objective of this study is to evaluate the impact of a nationwide 5-month course aimed to prepare surgeons for Major Incidents through the acquisition of key knowledge and competencies. Learners' satisfaction was also measured as a secondary objective. DESIGN This course was evaluated thanks to various teaching efficacy metrics, mainly based on Kirkpatrick's hierarchy in medical education. Gain in knowledge of participants was evaluated by multiple-choice tests. Self-reported confidence was measured with 2 detailed pre and post training questionnaires. SETTING Creation in 2020 of a nationwide, optional and comprehensive Surgical Training in War and Disaster Situation as part of the French surgery residency program. In 2021, data was gathered regarding the impact of the course on participants' knowledge and competencies. PARTICIPANTS The study included 26 students in the 2021 cohort (13 residents and 13 practitioners). RESULTS Mean scores were significantly higher in the post-test compared to the pre-test, showing significant increase in participants' knowledge during the course: 73,3% vs. 47,3% respectively (p ≤ 0.001). Average learners' confidence scores to perform technical procedures showed at least a +1-point increase on the Likert scale for 65% of items tested (p ≤ 0.001). 89% of items showed at least a +1-point increase on the Likert scale when it came to average learners' confidence score on dealing with complicated situations (p ≤ 0.001). Our post-training satisfaction survey showed that 92% of all participants have noticed the impact of the course on their daily practice. CONCLUSION Our study shows that the third level of Kirkpatrick's hierarchy in medical education was reached. This course therefore appears to be meeting the objectives set by the Ministry of Health. Being only 2 years old, it is on the road to gathering momentum and further development.
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Affiliation(s)
- Juliette Fischer
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
| | - Sandrine Barbois
- Inria, CNRS, Grenoble INP, LJK, University Grenoble Alpes, Grenoble, France; Department Of Digestive and Acute Care Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 university, Lyon, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Academic Hospital, Clamart Cedex, France
| | - Pierre Haen
- Department of Maxillofacial Surgery, Laveran Military and Academic Hospital, Marseille, France
| | - Antoine Bertani
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Patrick Duhamel
- Department of Plastic surgery, Percy Military Academic Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Academic Hospital, Clamart, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, AP-HM, Conception Academic Hospital, Marseille, France
| | - Christian Piolat
- Department of Paediatric surgery, Grenoble Alpes University Hospital, Grenoble , France
| | - Frédéric Rongieras
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, APHP, Avicenne Academic Hospital, Sorbonne Paris Nord University, Bobigny France
| | - Paul Balandraud
- Department of General Surgery, Sainte-Anne Military Academic Hospital, Toulon, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
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13
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Kwon J, Lee M, Kim Y, Moon J, Huh Y, Song S, Kim S, Ko JI, Jung K. Trauma system establishment and outcome improvement: a retrospective national cohort study in South Korea. Int J Surg 2023; 109:2293-2302. [PMID: 37204433 PMCID: PMC10442102 DOI: 10.1097/js9.0000000000000481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Trauma is a major cause of mortality, disability, and health care costs worldwide. The establishment of a trauma system is known to solve these problems, but few studies have objectively evaluated the impact of a trauma system on outcomes. Since 2012, South Korea has established a national trauma system based on the implementation of 17 regional trauma centers nationwide and the improvement of the prehospital transfer system. This study aimed to measure the changes in performance and outcome according to the established national trauma system. MATERIAL AND METHODS In this national cohort-based, retrospective follow-up observational study, the authors calculated the preventable trauma death rate (PTDR) by conducting a multipanel review of patients who died in 2015, 2017, and 2019. Furthermore, the authors constructed a risk-adjusted mortality prediction model of 4 767 876 patients between 2015 and 2019 using the extended-International Classification of Disease Injury Severity Scores to compare outcomes. RESULTS The PTDR was lower in 2019 than in 2015 (15.7 vs. 30.5, P <0.001) and 2017 (15.7 vs. 19.9%, P <0.001) representing 1247 additional lives saved in 2019 compared to that in 2015. In the risk-adjusted model, total trauma mortality was highest in 2015 at 0.56%, followed by that in 2016 and 2017 (0.50%), 2018 (0.51%), and 2019 (0.48%), revealing a significant decrease in mortality over the years ( P <0.001 for trend), representing nearly 800 additional lives saved. The number of deaths for more severe patients with a probability of survival less than 0.25 significantly decreased from 81.50% in 2015 to 66.17% in 2019 ( P <0.001). CONCLUSIONS The authors observed a significant reduction in the PTDR and risk-adjusted trauma mortality in the 5-year follow-up since 2015 when the national trauma system was established. These findings could serve as a model for low-income and middle-income countries, where trauma systems are not yet established.
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Affiliation(s)
- Junsik Kwon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Myeonggyun Lee
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine
| | - Jonghwan Moon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Seoyoung Song
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Sora Kim
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Jung-in Ko
- Department of Emergency Medicine
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
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Fritz CL, Thomas SA, Galvagno SM, Thomas SH. Survival Benefit of Helicopter Scene Response for Patients with an Injury Severity Score of at Least Nine: A Systematic Review and Meta-Analysis. PREHOSP EMERG CARE 2023; 28:841-850. [PMID: 37406174 DOI: 10.1080/10903127.2023.2232453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND AIM Helicopter EMS (HEMS) is a well-established mode of rapid transportation for patients with need for time-sensitive interventions, especially in patients with significant traumatic injuries. Traditionally in the setting of trauma, HEMS is often considered appropriate when used for patients with "severe" injury as defined by Injury Severity Score (ISS) >15. This may be overly conservative, and patients with a lower ISS may benefit from HEMS-associated speed or care quality. Our objective was to perform a meta-analysis of trauma HEMS transports to evaluate for possible mortality benefit in injured cases defined by an ISS score >8, lower than the customary ISS cutoff of >15. METHODS A broad search of the literature was performed including PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials, and Google Scholar from the years 1970 to 2022. The gray literature and reference lists of included publications were also examined. We included studies with the outcome of mortality in HEMS vs control in trauma transports from scene of injury for patients (adult or pediatric) with ISS > 8. RESULTS Nine eligible studies were used in the final analysis: six in the primary analysis and three in sensitivity analysis due to patient overlap. All studies reported statistically significant survival benefit in HEMS compared to control group. The minimum survival odds ratio (OR) benefit observed was OR 1.15 (95% CI 1.06-1.25) and maximum was OR 2.04 (95% CI 1.18-3.57). Risk of bias tool (ROBINS-I) application yielded moderate to low risk of bias, mainly due to the observational nature of the studies included. CONCLUSIONS There was a statistically significant survival benefit in patients with ISS > 8 when HEMS was used over traditional ground ambulance transportation, although novel and more inclusive trauma triage criteria may be more appropriate in the future to guide HEMS utilization decision-making. Restricting HEMS to trauma patients with ISS >15 likely misses survival benefit that could be afforded to the subset of trauma patients with serious injury.
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Affiliation(s)
- Christie L Fritz
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - Sarah Alice Thomas
- Department of Molecular Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine & R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Alao DO, Cevik AA, Abu-Zidan FM. Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study. World J Emerg Surg 2023; 18:31. [PMID: 37118764 PMCID: PMC10148441 DOI: 10.1186/s13017-023-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
AIM To study the epidemiology and pattern of trauma-related deaths of hospitalized patients in Abu Dhabi Emirate, United Arab Emirates, in order to improve trauma management and injury prevention. METHODS The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centres in Abu Dhabi Emirate. We studied all patients who died on arrival or after admission to these hospitals from January 2014 to December 2019. RESULTS There were 453 deaths constituting 13.5% of all trauma deaths in the Abu Dhabi Emirate. The median (IQR) age of the patients was 33 (25-45) years, and 82% were males. 85% of the deaths occurred in the emergency department (ED) and the intensive care unit (ICU). Motor vehicle collision (63.8%) was the leading cause of death. 45.5% of the patients had head injury. Two of the seven hospitals admitted around 50% of all patients but accounted for only 25.8% of the total deaths (p < 0.001). Those who died in the ward (7%) were significantly older, median (IQR) age: of 65.5 (31.75-82.25) years, (p < 0.001), 34.4% of them were females (p = 0.09). The median (IQR) GCS of those who died in the ward was 15 (5.75-15) compared with 3 (3-3) for those who died in ED and ICU (P < 0.001). CONCLUSIONS Death from trauma predominantly affects young males with motor traffic collision as the leading cause. Over 85% of in-hospital deaths occur in the ICU and ED, mainly from head injuries. Injury prevention of traffic collisions through enforcement of law and improved hospital care in the ED and ICU will reduce trauma death.
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Affiliation(s)
- David O Alao
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates.
| | - Arif Alper Cevik
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Beaumont-Boileau R, Nadeau A, Tardif PA, Malo C, Emond M, Moore L, Clément J, Mercier E. Performance of a provincial prehospital trauma triage protocol: A retrospective audit. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231156263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Objective To assess the accuracy of a five-step prehospital trauma triage protocol ( Échelle québécoise de triage préhospitalier en traumatologie (EQTPT)) to identify patients requiring urgent and specialized in-hospital trauma care in the Capitale-Nationale region – Québec. Methods The medical records of trauma patients transported by ambulance to one of the five participating emergency departments (EDs) between November 2016 and March 2017 were reviewed. Our primary outcome was the need for one of the following urgent and specialized trauma care: endotracheal intubation in the ED, administration of ≥ 2 blood products in the ED, angioembolization or surgery (excluding single limb surgery) < 24 h and admission to the intensive care unit (ICU) or in-hospital trauma-related death. Results A total of 902 patients were included. The median age was 63 (interquartile range (IQR) 51) and 494 (54.8%) were female. The main trauma mechanism was falls (n = 592), followed by motor vehicle accidents (n = 201). Eighty-two (9.1%) patients required at least one urgent and specialized trauma care. Of those, 44 (53.6%) were identified as requiring transport to a level one trauma centre (steps 1–3), 16 were identified as requiring transport to a centre with a lower level of trauma designation (steps 4–5) while 22 (26.8%) did not meet any of the EQTPT criteria. For steps 1 to 3, the sensitivity was 53.7% (95% confidence interval (CI) 42.9–64.4) and the specificity was 81.7% (95% CI 79.1–84.4) in identifying patients requiring specialized trauma care. Conclusion The EQTPT lacked sensitivity and was poorly specific to identify trauma patients who need specialized in-hospital trauma care.
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Affiliation(s)
- Roxane Beaumont-Boileau
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Alexandra Nadeau
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Pier-Alexandre Tardif
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Christian Malo
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Marcel Emond
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Lynne Moore
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Julien Clément
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
- Département de Chirurgie, CHU de Québec, Québec, Canada
| | - Eric Mercier
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
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Conn LG, Nathens AB, Scales DC, Vogt K, Wong CL, Haas B. A qualitative study of older adult trauma survivors' experiences in acute care and early recovery. CMAJ Open 2023; 11:E323-E328. [PMID: 37041014 PMCID: PMC10095264 DOI: 10.9778/cmajo.20220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Older adults (aged ≥ 65 yr) account for a substantial proportion of hospital admissions for severe injury, yet little is known about their care experiences and views regarding outcomes. We sought to characterize the acute care and early recovery experiences of older adults who had been discharged after traumatic injury, with a long-term goal to inform the selection of patient-centred process and outcome measures in geriatric trauma. METHODS From June 2018 to September 2019, we conducted telephone interviews with adults aged 65 years or older who had been discharged after traumatic injury within 6 months from Sunnybrook or London Health Sciences Centres in Ontario, Canada. Using interpretive description and thematic analysis, we drew on social science theories of illness and aging for data interpretation. We analyzed data to the point of theoretical saturation. RESULTS We interviewed 25 trauma survivors aged 65-88 years. Most were injured in a fall. Four themes characterized participants' experiences, as follows: "I don't feel like a senior" (i.e., participants disliked being viewed as a senior or as needing senior-specific care); "don't bother telling him anything" (i.e., participants perceived ageist assumptions and treatment in acute care processes); getting back to normal (i.e., participants emphasized their active lifestyles and functional recovery as goals of care); "I have lost control of my life" (i.e., substantial social and personal losses linked to participants' experiences and adaptations to aging generally). INTERPRETATION Findings suggest that older adults experience social and personal loss after injury, and underscore how implicit age bias may influence care experiences and outcomes. This can inform improvements in injury care and guide providers in the selection of patient-centred outcome measures.
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Affiliation(s)
- Lesley Gotlib Conn
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont.
| | - Avery B Nathens
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Damon C Scales
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Kelly Vogt
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Camilla L Wong
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
| | - Barbara Haas
- Sunnybrook Research Institute (Gotlib Conn, Nathens, Scales, Haas), Sunnybrook Health Sciences Centre; Departments of Anthropology (Gotlib Conn) and Surgery (Nathens, Haas), and Interdepartmental Division of Critical Care (Scales, Haas), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Vogt); Department of Surgery (Vogt), Western University, London, Ont.; Li Ka Shing Knowledge Institute (Wong), St Michael's Hospital; Department of Medicine (Wong), University of Toronto, Toronto, Ont
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Population-Based Assessment of Urban Versus Rural Child Fatalities From Firearms in a Midwestern State. J Surg Res 2023; 283:52-58. [PMID: 36370682 DOI: 10.1016/j.jss.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/22/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Several studies have evaluated differences in firearm injury patterns among children based on regionalization. However, many of these studies exclude patients who die before arriving at a trauma center. We therefore hypothesize that important population-based differences in pediatric firearm injuries may be uncovered with the inclusion of both prehospital firearm mortalities and patients treated at a tertiary children's hospital. METHODS Patients less than 15 y of age who sustained a firearms-related injury/death between the years 2012 and 2018 were identified in: (1) death certificates from the Office of Vital Statistics State of Indiana and (2) Riley Hospital for Children at Indiana University Health Trauma Registry. Counties of injury were classified as either urban, midsized, or rural based on the National Center for Health Statistic's population data. Significant variables in univariate analysis were then assessed using multivariate logistic regression models. RESULTS A total of 222 patients were identified. Median age of firearm injury survivors was 13 (interquartile range 7-14), while the median age of nonsurvivors was 14 (interquartile range 11-15), P = 0.040. The proportion of suicide was significantly higher in rural counties (P < 0.001). When controlling for shooter intent, patients from a rural or midsized county had statistically significant higher odds of dying before reaching a hospital than their urban counterpart (rural odds ratio [OR] 5.67 [95% confidence interval {CI} 2.23, 14.38]; midsized OR 6.53 [95% CI 2.43, 17.46]; P < 0.001). CONCLUSIONS Important differences exist between pediatric firearm injuries based on where they occur. Public health initiatives aimed at reducing pediatric firearm injury and death should not exclude rural pediatrics patients.
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Carroll Á, Sukumar P, O’Keeffe A. The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data. BMC Health Serv Res 2023; 23:175. [PMID: 36810087 PMCID: PMC9942335 DOI: 10.1186/s12913-023-09177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Globally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe. METHODS A retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher's exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports. RESULTS 338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require. CONCLUSION Data linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.
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Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, D04 V1W8, Belfield, Dublin, Ireland. .,National Rehabilitation University Hospital, Rochestown Avenue, Dun Laoghaire, A96 E2H2, Dublin, Ireland.
| | - Prasanth Sukumar
- grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, D04 V1W8 Belfield, Dublin, Ireland
| | - Aisling O’Keeffe
- grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, D04 V1W8 Belfield, Dublin, Ireland
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20
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Surgical stabilization of critical abdominal injuries in a mature rural trauma system: A retrospective study. J Trauma Acute Care Surg 2023; 94:248-257. [PMID: 36694334 DOI: 10.1097/ta.0000000000003841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Worse outcomes following injuries are more likely in rural versus urban areas. In 2001, our state established an inclusive trauma system to improve mortality. In 2015, the trauma system had a consultation visit from the American College of Surgeons' Committee on Trauma, who made several recommendations. We hypothesized that continued maturation of this system would lead to more laparotomies prior to transfer to a higher level of care and better outcomes. METHODS Our trauma registry was queried to identify all patients transferred between January 1, 2010, and December 31, 2020, who underwent laparotomy either before transfer or within 4 hours of arrival. The preconsultation (2010-2015) and postconsultation periods (2016-2020) were compared. Categorical and continuous variables were compared using χ2 and Mann-Whitney U tests, respectively. RESULTS We included 213 patients; 63 had laparotomy before transfer and 150 within 4 hours after transfer. Age, injury severity scores, systolic blood pressure, and mechanism of injury were not different between periods. Proportions of laparotomy before and after transfer and outcomes (mortality, hospital length of stay, intensive care unit length of stay, ventilator days) were also similar (p = 0.368 for laparotomy, p = 0.840, 0.124, 0.286, 0.822 for outcomes). Compared with the preconsultation period, the proportion of laparotomy performed before transfer for severe injuries (abdominal Abbreviated Injury Scale score >3) significantly increased postconsultation (57.1% vs. 30.6%, p = 0.011). Incidence of damage-control laparotomies (43.9% vs. 23.6%; p = 0.020) and transfusion of plasma and platelets (33.6% vs. 13.2%; p < 0.001, 22.4% vs. 8.5%, p = 0.007, respectively) significantly increased. CONCLUSION Identification and surgical stabilization of critical patients at the non-Level I facilities prior to transfer, as well as blood product use and damage-control techniques, improved postconsultation, suggesting a shift in the approaches to surgical stabilization and resuscitation efforts in our trauma system. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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21
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Serna CA, Caicedo Y, Salcedo A, Rodríguez-Holguín F, Serna JJ, Palacios H, Pino LF, Leib P, Peláez JD, Fuertes-Bucheli J, García A, Ordoñez CA. De un centro de trauma a un sistema de trauma en el suroccidente colombiano. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma.
Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad.
Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad.
Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad.
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A Propensity Score-Matched Comparison of In-Hospital Mortality between Dedicated Regional Trauma Centers and Emergency Medical Centers in the Republic of Korea. Emerg Med Int 2022; 2022:5749993. [PMID: 36438862 PMCID: PMC9683976 DOI: 10.1155/2022/5749993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background In the Republic of Korea, a trauma care system was not created until 2012, at which point regional trauma centers (RTCs) were established nationwide. In accordance with the national emergency care system and legislation, regional and local emergency medical centers (EMCs) also treat patients presenting with trauma. The aim of the present study was to assess whether treatment in RTCs is truly associated with better patient outcomes than that in EMCs by means of propensity score-matched comparisons and to identify populations that would benefit from treatment in RTCs. Methods This study analyzed the data of patients with consecutive emergency visits between January 1, 2018, and December 31, 2018, collected in the National Emergency Department Information System registry. Data from RTCs, designated regional EMCs, or local EMCs were included; data from smaller emergency departments were excluded because, in Korea, dedicated RTCs are established only in hospitals with regional or local EMCs. Propensity scores for treatment in RTCs or EMCs were estimated by logistic regression using linear terms. Mortality rates in RTCs and EMCs were compared between the matched samples. Results The in-hospital mortality rates in the matched cases treated in RTCs and EMCs were 1.4% and 1.6%, respectively. The odds ratio for in-hospital mortality in RTCs over EMCs was 0.984 (95% confidence interval: 0.813–1.191). Among the subgroups evaluated, the subgroup of patients with injuries involving the chest or lower limbs showed a significant difference in the in-hospital mortality rate. Conclusion There was no significant difference in the overall severity-adjusted mortality rate between patients treated in RTCs and EMCs. Treatment in an RTC might benefit those with injuries involving the chest or lower limbs.
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Soni KD, Bansal V, Arora H, Verma S, Wärnberg MG, Roy N. The State of Global Trauma and Acute Care Surgery/Surgical Critical Care. Crit Care Clin 2022; 38:695-706. [PMID: 36162905 DOI: 10.1016/j.ccc.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma is a leading cause of morbidity and mortality globally, with a significant burden attributable to the low- and middle-income countries (LMICs), where more than 90% of injury-related deaths occur. Road injuries contribute largely to the economic burden from trauma and are prevalent among adolescents and young adults. Trauma systems vary widely across the world in their capacity of providing basic and critical care to injured patients, with delays in treatment being present at multiple levels at LMICs. Strengthening existing systems by providing cost-effective and efficient solutions can help mitigate the injury burden in LMICs.
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Affiliation(s)
- Kapil Dev Soni
- Critical & Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Ring Road, Raj Nagar, Safdarjung Enclave, New Delhi, Delhi 110029, India
| | - Varun Bansal
- Department of General Surgery, 2nd Floor Registration Building, Seth G.S.M.C. and K.E.M. Hospital, Parel, Mumbai 400012, India
| | - Harshit Arora
- Department of Surgery, Punjab Institute of Medical Sciences, Gadha Road, Jalandhar, Punjab 144006, India
| | - Sukriti Verma
- Department of Blood Bank, Guru Teg Bahadur Hospital, Tahirpur Rd, GTB Enclave, Dilshad Garden, New Delhi, Delhi 110095, India; WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18, 171 65 Solna, Stockholm 171 65, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, SE - 171 76, Stockholm, Sweden
| | - Nobhojit Roy
- WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India; The George Institute of Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, Delhi 110025, India.
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Mansour T, Beck B, Gabbe B, Farhat I, Belcaid A, Neveu X, Moore L. International comparison of injury care structures, processes, and outcomes between integrated trauma systems in Québec, Canada, and Victoria, Australia. Injury 2022; 53:2907-2914. [PMID: 35688707 DOI: 10.1016/j.injury.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Quality improvement activities in trauma systems are widely based on comparisons between trauma centers within the same system. Comparisons across different trauma systems may reveal further opportunities for quality improvement. OBJECTIVES This study aimed to compare the integrated trauma systems in Québec, Canada and in Victoria, Australia, regarding their structures, care processes and patient outcomes. METHODOLOGY The elements recommended by the American College of Surgeons were used to compare trauma systems structures. Comparisons of care processes and patient outcomes were based on data from major trauma admissions extracted from trauma registries (2013 and 2017). Care processes included time to reach a definitive care facility, time spent in the emergency department, and time lapsed before the first head computed tomography (CT) scan. These care processes were compared using a z-test of log-transformed times. Hospital mortality and hospital length of stay (LOS) were compared using indirect standardization based on multiple logistic and linear regression. RESULTS Major differences in trauma system structure were Advanced Trauma Life Support at the scene of injury (Victoria), the use of validated prehospital triage tools (Québec), and mandatory accreditation of all trauma centers (Québec). Patients in Québec arrived at their definitive care hospital earlier than their counterparts in Victoria (median: 1.93 vs. 2.13 h, p = 0.002), but spent longer in the emergency department (median: 8.23 vs. 5.15 h, p<0.0001) and waited longer before having their first head CT (median: 1.90 vs. 1.52 h, p<0.0001). In-hospital mortality and hospital LOS were higher in Québec than in Victoria (standardized mortality ratio: 1.15, 95% CI: 1.09 - 1.20; standardized LOS ratio: 1.10, 95% CI: 1.09 - 1.11). CONCLUSION We observed important differences in the structural components and care processes in Québec and Victoria's trauma systems, which might explain some of the observed differences in patient outcomes. This study shows the potential value of international comparisons in trauma care and identifies possible opportunities for quality improvement.
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Affiliation(s)
- Thowiba Mansour
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada; Axe de Recherche: Santé des Populations et Pratiques Optimales en Santé (Traumatologie - Urgence - Soins intensifs), Centre de Recherche du CHU de Québec, Québec, QC, Canada
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Imen Farhat
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Québec, QC, Canada
| | - Amina Belcaid
- Institut National d'Excellence en Santé et en Services Sociaux (INESSS), Québec, QC, Canada
| | - Xavier Neveu
- Axe de Recherche: Santé des Populations et Pratiques Optimales en Santé (Traumatologie - Urgence - Soins intensifs), Centre de Recherche du CHU de Québec, Québec, QC, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada; Axe de Recherche: Santé des Populations et Pratiques Optimales en Santé (Traumatologie - Urgence - Soins intensifs), Centre de Recherche du CHU de Québec, Québec, QC, Canada.
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25
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Razzak JA, Bhatti J, Wright K, Nyirenda M, Tahir MR, Hyder AA. Improvement in trauma care for road traffic injuries: an assessment of the effect on mortality in low-income and middle-income countries. Lancet 2022; 400:329-336. [PMID: 35779549 DOI: 10.1016/s0140-6736(22)00887-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 02/18/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
Abstract
Over 90% of the annual 1·35 million worldwide deaths due to road traffic injuries (RTIs) occur in low-income and middle-income countries (LMICs). For this Series paper, our aim was two-fold. Firstly, to review evidence on effective interventions for victims of RTIs; and secondly, to estimate the potential number of lives saved by effective trauma care systems and clinical interventions in LMICs. We reviewed all the literature on trauma-related health systems and clinical interventions published during the past 20 years using MEDLINE, Embase, and Web of Science. We included studies in which mortality was the primary outcome and excluded studies in which trauma other than RTIs was the predominant injury. We used data from the Global Status Report on Road Safety 2018 and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved in LMICs. Of the 1921 studies identified for our review of the literature, 62 (3·2%) met the inclusion criteria. Only 28 (1·5%) had data to calculate relative risk. We found that more than 200 000 lives per year can be saved globally with the implementation of a complete trauma system with 100% coverage in LMICs. Partial system improvements such as establishing trauma centres (>145 000 lives saved) and instituting and improving trauma teams (>115 000) were also effective. Emergency medical services had a wide range of effects on mortality, from increasing mortality to saving lives (>200 000 excess deaths to >200 000 lives saved per year). For clinical interventions, damage control resuscitation (>60 000 lives saved per year) and institution of interventional radiology (>50 000 lives saved per year) were the most effective interventions. On the basis of the scarce evidence available, a few key interventions have been identified to provide guidance to policy makers and clinicians on evidence-based interventions that can reduce deaths due to RTIs in LMICs. We also highlight important gaps in knowledge on the effects of other interventions.
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Affiliation(s)
- Junaid A Razzak
- Weill Cornell Medical Centre, New York, NY, USA; College of Medicine, Aga Khan University, Karachi Pakistan.
| | | | - Kate Wright
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA
| | - Mulinda Nyirenda
- College of Medicine, University of Malawi, Blantyre, Malawi; Ministry of Health, Blantyre, Malawi
| | | | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Yasin YJ, Eid HO, Alao DO, Grivna M, Abu-Zidan FM. Reduction of motorcycle-related deaths over 15 years in a developing country. World J Emerg Surg 2022; 17:21. [PMID: 35488275 PMCID: PMC9051744 DOI: 10.1186/s13017-022-00426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates. METHODS This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied. RESULTS The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test). CONCLUSIONS The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.
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Affiliation(s)
- Yasin J Yasin
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hani O Eid
- Rescue and Air Ambulance, Abu Dhabi Police Aviation, Abu Dhabi, United Arab Emirates
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Emergency Department, Al-Ain Hospital, Al-Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Department of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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Jung K, Kwon J, Huh Y, Moon J, Hwang K, Cho HM, Kim JH, Park CI, Yun JH, Kim OH, Lee KJ, Kim S, Lim B, Kim Y. National trauma system establishment based on implementation of regional trauma centers improves outcomes of trauma care: A follow-up observational study in South Korea. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000162. [PMID: 36962235 PMCID: PMC10021375 DOI: 10.1371/journal.pgph.0000162] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Abstract
Although South Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates of more than 30%. Since 2012, South Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness. We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels, and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores. The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53-0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47 806) to 1.9% (1062/55 057) (p = 0.041). The establishment of the national trauma system was associated with significant improvements in the performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.
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Affiliation(s)
- Kyoungwon Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Junsik Kwon
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Yo Huh
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jonghwan Moon
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Kyungjin Hwang
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Hyun Min Cho
- Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju, South Korea
| | - Jae Hun Kim
- Department of Trauma and Surgical Critical Care, Pusan National University College of Medicine, Busan, South Korea
| | - Chan Ik Park
- Department of Trauma and Surgical Critical Care, Pusan National University College of Medicine, Busan, South Korea
| | - Jung-Ho Yun
- Department of Neurosurgery, Dankook University College of Medicine, Cheon-an, South Korea
| | - Oh Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Won-ju, South Korea
| | - Kee-Jae Lee
- Department of Information and Statistics, Korea National Open University, Seoul, South Korea
| | - Sunworl Kim
- National Emergency Medical Center, National Medical Center (NMC), Seoul, South Korea
| | - Borami Lim
- National Emergency Medical Center, National Medical Center (NMC), Seoul, South Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
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Intention to Stay in Specialist Trauma Nurses: Relationship With Role Conflict, Stress, and Organizational Support. J Trauma Nurs 2022; 29:21-28. [PMID: 35007247 DOI: 10.1097/jtn.0000000000000628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Specialist trauma nurses contribute to shortening hospital stay, lowering intensive care unit readmission rates, and improving treatment outcomes through early detection and management of health problems in trauma patients. However, Korean specialist trauma nurses have a higher turnover rate than other nurses due to negative factors like unclear job descriptions and inconsistent job activities. OBJECTIVE This study aimed to examine the levels of and relationships among role conflict, occupational stress, perceived organizational support, and intent to stay in Korean specialist trauma nurses. METHODS We enrolled 53 specialist trauma nurses from eight regional trauma centers in Korea. Data on role conflict, occupational stress, perceived organizational support, and intent to stay were collected using a structured questionnaire. Mann-Whitney U test, Kruskal-Wallis test, and Bonferroni post hoc tests were conducted to examine differences in intent to stay. Spearman's correlation coefficients were used to examine correlations between the key variables. RESULTS High intent to stay was associated with periodic job training, job satisfaction, and perceived high workload. Role conflict was positively correlated with occupational stress, whereas both were negatively correlated with perceived organizational support. Intent to stay was negatively correlated with occupational stress and positively correlated with perceived organizational support. CONCLUSIONS Effective improvement measures that lower occupational stress and increase perceived organizational support will help maintain the positions of specialist trauma nurses. These results highlight the need to specify the scope of practice and implement practical measures like career development programs that enhance professional nursing competencies to retain specialist trauma nurses.
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O'Reilly GM, Fitzgerald MC, Curtis K, Mathew JK. Making trauma registries more useful for improving patient care: A survey of trauma care and trauma registry stakeholders across Australia and New Zealand. Injury 2021; 52:2848-2854. [PMID: 34362560 DOI: 10.1016/j.injury.2021.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is a major global health burden. Trauma registries have been used for decades to monitor the burden of injury and inform trauma care. However, the extent to which trauma registries have fulfilled their potential remains uncertain. The aims of this study were to determine the current and priority uses of trauma registries across Australia and New Zealand and to establish the priority clinical outcomes, the probability for which, if known for an individual trauma patient, would better inform that same patient's care, during hospital admission. METHODS A prospective observational study using survey methodology was conducted. Participants were sourced from the Australia New Zealand Trauma Registry (ATR) participating hospitals. The survey questions included: the current uses and priorities for both single-site trauma registries and the binational trauma registry; the five top-ranked priority outcomes for which knowing the probability, for an individual patient, would inform care; and the priority timepoints for applying patient-level outcome prediction models. RESULTS Of the 26 ATR-participating hospitals, 25 were represented by a total of 54 participants in the survey, including trauma service directors and trauma nurse coordinators. The main trauma registry use and priority for the single site registries was to inform the quality improvement program; for the ATR, the main use was periodic reporting and the main priority was benchmarking. For each potential purpose of the registry, the future priority level was ranked more highly than the current level of utilisation. The most highly ranked priority patient-level outcomes requiring prediction were: preventable death, missed injury, quality of life, admission costs, pulmonary embolism, post-traumatic stress disorder, length of hospital stay, errors in decision-making and deep venous thrombosis. The time period between leaving the emergency department and the 24 h mark following presentation was considered the preferred time for patient-level priority outcome prediction. CONCLUSION There is a mismatch between current trauma registry uses and future priorities. The priority outcomes demanding prediction in the first 24 h of a trauma patient's stay are preventable death, missed injury, quality of life, hospital costs, thromboembolism, post-traumatic stress disorder, length of hospital stay and errors in clinical decision-making.
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Affiliation(s)
- Gerard M O'Reilly
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Software and Innovation Lab, Deakin University, Melbourne, Australia.
| | - Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong NSW, Australia; Illawarra Health and Medical Research Institute, Building 32 University of Wollongong, Northfields Avenue, Wollongong NSW, Australia; George Institute for Global Health, University of NSW, Australia; Faculty of Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong NSW, Australia.
| | - Joseph K Mathew
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia; Software and Innovation Lab, Deakin University, Melbourne, Australia.
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Are Trauma Surgery Simulation Courses Beneficial in Low- and Middle-Income Countries—A Systematic Review and Meta-Analysis. TRAUMA CARE 2021. [DOI: 10.3390/traumacare1030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite trauma-related injuries being a leading cause of death worldwide, low- and middle-income countries (LMICs) lack the infrastructure and resources required to offer immediate surgical care, further perpetuating the risk of morbidity and mortality. In high-income countries, trauma surgery simulation courses are routinely delivered to surgeons, teaching the fundamental skills of operative trauma. This study aimed to assess whether similar courses are beneficial in LMICs and how they can be improved. We performed a systematic review and meta-analysis using MEDLINE, Embase and Google Scholar, analysing studies evaluating trauma surgery simulation in LMICs. The outcomes measured included clinical knowledge improvement, participant confidence and general course-feedback. The review was carried out in-line with PRISMA guidelines. Five studies were included, summating a population of 172 participants. In three studies, meta-analysis showed an overall significant weighted mean improvement of knowledge post-course by 22.91% (95%CI 19.53, 26.29; p < 0.00001; I2 = 0%). One study reported a significant increase in participant confidence for 20/22 of operative skills taught (p < 0.04). We conclude that these courses are beneficial in LMICs; however, further research is necessary to establish the optimum course design, and whether patient outcomes are improved following their implementation. Collaboration between international trauma institutions is essential for closing the educational resource inequality gap between higher- and lower-income countries.
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Alharbi RJ, Shrestha S, Lewis V, Miller C. The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis. World J Emerg Surg 2021; 16:38. [PMID: 34256793 PMCID: PMC8278750 DOI: 10.1186/s13017-021-00381-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development. METHOD A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI). RESULTS A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001). CONCLUSION The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019142842 .
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Affiliation(s)
- Rayan Jafnan Alharbi
- School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, Bundoora, VIC, 3086, Australia. .,Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia.
| | - Sumina Shrestha
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.,Community Development and Environment Conservation Forum, Chautara, Nepal
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Charne Miller
- School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, Bundoora, VIC, 3086, Australia
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Alharbi RJ, Lewis V, Shrestha S, Miller C. Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e047439. [PMID: 34083344 PMCID: PMC8183269 DOI: 10.1136/bmjopen-2020-047439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally. METHODS AND ANALYSIS The proposed review will comply with the checklist of the 'Preferred reporting items for systematic review and meta-analysis'. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review. ETHICS AND DISSEMINATION This systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42019142842.
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Affiliation(s)
- Rayan Jafnan Alharbi
- School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
- Department of Emergency Medical Service, Jazan University, Jazan, Jazan, Saudi Arabia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
| | - Sumina Shrestha
- Australian Institute for Primary Care and Ageing, School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
- Community Development and Environment Conservation Forum, Nepal, Nepal
| | - Charne Miller
- School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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Effectiveness of Quality Improvement Processes, Interventions, and Structure in Trauma Systems in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. World J Surg 2021; 45:1982-1998. [PMID: 33835217 DOI: 10.1007/s00268-021-06065-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trauma mortality in low- and middle-income countries (LMICs) remains high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to decrease trauma mortality. METHODS A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country trauma systems was conducted from November 1989 to August 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC population according to World Bank Income Classification, occurred in a trauma setting, and measured the effect of implementation and its impact. The primary outcome was trauma mortality. RESULTS Of 37,575 search results, 30 studies were included from 15 LMICs covering five WHO regions in a qualitative synthesis. Twenty-seven articles were included in a meta-analysis. Implementing a pre-hospital trauma system reduced overall trauma mortality by 45% (risk ratio (RR) 0.55, 95% CI 0.4 to 0.75). Training first responders resulted in an overall decrease in mortality (RR 0.47, 95% CI 0.28 to 0.78). In-hospital trauma training with certified courses resulted in a reduction of mortality (RR 0.71, 95% CI 0.62 to 0.78). Trauma audits and trauma protocols resulted in varying improvements in trauma mortality. CONCLUSION There is evidence that quality improvement processes, interventions, and structure can improve mortality in the trauma systems in LMICs.
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Driessen MLS, Sturms LM, van Zwet EW, Bloemers FW, Ten Duis HJ, Edwards MJR, den Hartog D, de Jongh MAC, Leenhouts PA, Poeze M, Schipper IB, Spanjersberg R, Wendt KW, de Wit RJ, van Zutphen SWAM, Leenen LPH. Evaluation of the Berlin polytrauma definition: A Dutch nationwide observational study. J Trauma Acute Care Surg 2021; 90:694-699. [PMID: 33443988 DOI: 10.1097/ta.0000000000003071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Berlin polytrauma definition (BPD) was established to identify multiple injury patients with a high risk of mortality. The definition includes injuries with an Abbreviated Injury Scale score of ≥3 in ≥2 body regions (2AIS ≥3) combined with the presence of ≥1 physiological risk factors (PRFs). The PRFs are based on age, Glasgow Coma Scale, hypotension, acidosis, and coagulopathy at specific cutoff values. This study evaluates and compares the BPD with two other multiple injury definitions used to identify patients with high resource utilization and mortality risk, using data from the Dutch National Trauma Register (DNTR). METHODS The evaluation was performed based on 2015 to 2018 DNTR data. First, patient characteristics for 2AIS ≥3, Injury Severity Score (ISS) of ≥16, and BPD patients were compared. Second, the PRFs prevalence and odds ratios of mortality for 2AIS ≥3 patients were compared with those from the Deutsche Gesellschaft für Unfallchirurgie Trauma Register. Subsequently, the association between PRF and mortality was assessed for 2AIS ≥3-DNTR patients and compared with those with an ISS of ≥16. RESULTS The DNTR recorded 300,649 acute trauma admissions. A total of 15,711 patients sustained an ISS of ≥16, and 6,263 patients had suffered a 2AIS ≥3 injury. All individual PRFs were associated with a mortality of >30% in 2AIS ≥3-DNTR patients. The increase in PRFs was associated with a significant increase in mortality for both 2AIS ≥3 and ISS ≥16 patients. A total of 4,264 patients met the BPDs criteria. Overall mortality (27.2%), intensive care unit admission (71.2%), and length of stay were the highest for the BPD group. CONCLUSION This study confirms that the BPD identifies high-risk patients in a population-based registry. The addition of PRFs to the anatomical injury scores improves the identification of severely injured patients with a high risk of mortality. Compared with the ISS ≥16 and 2AIS ≥3 multiple injury definitions, the BPD showed to improve the accuracy of capturing patients with a high medical resource need and mortality rate. LEVEL OF EVIDENCE Epidemiological study, level III.
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Affiliation(s)
- Mitchell L S Driessen
- From the Dutch Network for Emergency Care (M.L.S.D., L.M.S.), Utrecht; Department of Medical Statistics (E.W.v.Z.), Leiden University Medical Center, Leiden; Department of Surgery (F.W.B.), Amsterdam University Medical Center, VU, Amsterdam; Department of Trauma Surgery (M.J.R.E.), Radboud University Medical Center, Nijmegen; Trauma Research Unit, Department of Surgery (D.d.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam; Brabant Trauma Registry (M.A.C.d.J.), Network Emergency Care Brabant, Tilburg; Department of Surgery (P.A.L.), Amsterdam University Medical Center, AMC, Amsterdam; Department of Surgery (M.P.), Maastricht University Medical Center, Maastricht; Department of Trauma Surgery (I.B.S.), Leiden University Medical Center, Leiden; Department of Trauma Surgery (R.S.), Isala Hospitals, Zwolle; Department of Trauma Surgery (K.W.W.), University Medical Center Groningen, Groningen; Department of Trauma Surgery (R.J.d.W.), Medical Spectrum Twente, Enschede; Department of Surgery Elisabeth Two Cities Hospital (S.W.A.M.v.Z.), Tilburg; and Department of Surgery (L.P.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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Engels PT, Coates A, MacDonald RD, Ahghari M, Welsford M, Dodd T, Turcotte K, Doyle JD, Eugenio AM, Green JP, Irvine JE, Lysecki PJ, Sandhanwalia SK, Sharma SV. Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma-System Performance Improvement and Knowledge Exchange (T-SPIKE) project. Can J Surg 2021; 64:E162-E172. [PMID: 33720676 PMCID: PMC8064245 DOI: 10.1503/cjs.000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background There is currently no integrated data system to capture the true burden of injury and its management within Ontario’s regional trauma networks (RTNs), largely owing to difficulties in identifying these patients across the multiple health care provider records. Our project represents an iterative effort to create the ability to chart the course of care for all injured patients within the Central South RTN. Methods Through broad stakeholder engagement of major health care provider organizations within the Central South RTN, we obtained research ethics board approval and established data-sharing agreements with multiple agencies. We tested identification of trauma cases from Jan. 1 to Dec. 31, 2017, and methods to link patient records between the various echelons of care to identify barriers to linkage and opportunities for administrative solutions. Results During 2017, potential trauma cases were identified within ground paramedic services (23 107 records), air medical transport services (196 records), referring hospitals (7194 records) and the lead trauma hospital trauma registry (1134 records). Linkage rates for medical records between services ranged from 49% to 92%. Conclusion We successfully conceptualized and provided a preliminary demonstration of an initiative to collect, collate and accurately link primary data from acute trauma care providers for certain patients injured within the Central South RTN. Administration-level changes to the capture and management of trauma data represent the greatest opportunity for improvement.
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Affiliation(s)
- Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Angela Coates
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Russell D MacDonald
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Mahvareh Ahghari
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Michelle Welsford
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Tim Dodd
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Katie Turcotte
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Jeffrey D Doyle
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Arthur M Eugenio
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Jason P Green
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - J Eric Irvine
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Paul J Lysecki
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Simerpreet K Sandhanwalia
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Sunjay V Sharma
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
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Lilley R, Kool B, Davie G, de Graaf B, Dicker B. Opportunities to prevent fatalities due to injury: a cross-sectional comparison of prehospital and in-hospital fatal injury deaths in New Zealand. Aust N Z J Public Health 2021; 45:235-241. [PMID: 33522676 DOI: 10.1111/1753-6405.13068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There is interest in opportunities that lie in the prehospital setting to reduce the substantial burden of fatal injury. This study examines the epidemiology of prehospital and in-hospital fatal injury in New Zealand. METHODS All deaths registered in 2008-2012 with an underlying cause of death external cause-code V01-Y36 (ICD-10-AM) were identified. The setting of death was determined following linkage to, and review of, hospital discharge data and Coronial records. RESULTS Of 7,522 injury deaths, 80% occurred in a prehospital setting, with the highest burden relating to males. Within those fatally injured, 25-54-year-olds had a higher risk of prehospital death than 55-84-year-olds (adjusted Relative Risk [aRR] 1.20, 95%CI 1.16, 1.20). Similarly, those injured due to drowning (aRR 1.39, CI 1.26, 1.53) and non-hanging suffocation (aRR 1.31, CI 1.18, 1.45) had a higher risk of prehospital death than those 'struck by/machinery'. CONCLUSION Prehospital deaths account for four out of five fatal injuries in New Zealand. Of the fatally injured population, the probability of prehospital death differed by age, sex, injury mechanism and intent. Implications for public health: This study highlights the importance of strengthening prevention efforts to reduce the substantive burden of prehospital fatalities in New Zealand.
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Affiliation(s)
- Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Bridget Dicker
- St Johns, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, New Zealand
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Jiang L, Zheng Z, Zhang M. The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients. World J Emerg Surg 2020; 15:59. [PMID: 33076958 PMCID: PMC7574576 DOI: 10.1186/s13017-020-00340-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. Conclusion The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.
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Affiliation(s)
- Libing Jiang
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang road 88, Hangzhou, China
| | - Zhongjun Zheng
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang road 88, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang road 88, Hangzhou, China.
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Mackenzie CF, Elster EA, Bowyer MW, Sevdalis N. Scoping Evidence Review on Training and Skills Assessment for Open Emergency Surgery. JOURNAL OF SURGICAL EDUCATION 2020; 77:1211-1226. [PMID: 32224033 DOI: 10.1016/j.jsurg.2020.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Scope evidence on technical performance metrics for open emergency surgery. Identify surgical performance metrics and procedures used in trauma training courses. DESIGN Structured literature searches of electronic databases were conducted from January 2010 to December 2019 to identify systematic reviews of tools to measure surgical skills employed in vascular or trauma surgery evaluation and training. SETTING AND PARTICIPANTS Faculty of Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland and Implementation Science, King's College, London. RESULTS The evidence from 21 systematic reviews including over 54,000 subjects enrolled into over 840 eligible studies, identified that the Objective Structured Assessment of Technical Skill was used for elective surgery not for emergency trauma and vascular control surgery procedures. The Individual Procedure Score (IPS), used to evaluate emergency trauma procedures performed before and after training, distinguished performance of residents from experts and practicing surgeons. IPS predicted surgeons who make critical errors and need remediation interventions. No metrics showed Kirkpatrick's Level 4 evidence of technical skills training benefit to emergency surgery outcomes. CONCLUSIONS Expert benchmarks, errors, complication rates, task completion time, task-specific checklists, global rating scales, Objective Structured Assessment of Technical Skills, and IPS were found to identify surgeons, at all levels of seniority, who are in need of remediation of technical skills for open surgical hemorrhage control. Large-scale, multicenter studies are needed to evaluate any benefit of trauma technical skills training on patient outcomes.
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Affiliation(s)
| | - Eric A Elster
- The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Mark W Bowyer
- The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nick Sevdalis
- Center for Implementation Science, King's College, London, United Kingdom
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Lecky FE, Reynolds T, Otesile O, Hollis S, Turner J, Fuller G, Sammy I, Williams-Johnson J, Geduld H, Tenner AG, French S, Govia I, Balen J, Goodacre S, Marahatta SB, DeVries S, Sawe HR, El-Shinawi M, Mfinanga J, Rubiano AM, Chebbi H, Do Shin S, Ferrer JME, Haddadi M, Firew T, Taubert K, Lee A, Convocar P, Jamaluddin S, Kotecha S, Yaqeen EA, Wells K, Wallis L. Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise. BMC Emerg Med 2020; 20:68. [PMID: 32867675 PMCID: PMC7457362 DOI: 10.1186/s12873-020-00362-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. METHODS The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. RESULTS The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care - all within LMICs. CONCLUSIONS Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.
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Affiliation(s)
- Fiona E Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | | | - Olubukola Otesile
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Sara Hollis
- World Health Organisation, Geneva, Switzerland
| | - Janette Turner
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Gordon Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Ian Sammy
- Scarborough General Hospital, Tobago, Canada
| | | | - Heike Geduld
- Divsion of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | | | | | - Ishtar Govia
- The University of West Indies, Kingston, Jamaica
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | | | - Shaheem DeVries
- Emergency Medical Services for the Western Cape Government, Cape Town, South Africa
| | - Hendry R Sawe
- Emergency Medical Association of Tanzania (EMAT), Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | | | - Juma Mfinanga
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Andrés M Rubiano
- Neurosciences Institute, El Bosque University, Bogotá, Colombia
- Colombian Trauma Association, Bogotá, Colombia
| | | | - Sang Do Shin
- Seoul National University Hospital, Seoul, South Korea
| | | | | | - Tsion Firew
- Columbia University, Emergency Medicine, New York, NY, USA
- Ministry of Health, Addis Ababa, Ethiopia
| | | | - Andrew Lee
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Pauline Convocar
- Philippine College of Emergency Medicine, Parañaque, Philippines
| | | | | | | | - Katie Wells
- Divsion of Emergency Medicine, University of Vermont, Burlington, Vermont, USA
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, F51 Old Main Building, Groote Schuur Hospital Observatory, Cape Town, South Africa.
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Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury. World J Emerg Surg 2020; 15:49. [PMID: 32811505 PMCID: PMC7437038 DOI: 10.1186/s13017-020-00327-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Trauma is a leading cause of death in the United Arab Emirates (UAE). There have been major developments in the trauma system in Al-Ain City during the last two decades. We aimed to study the effects of these developments on the trauma pattern, severity, and clinical outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates. Methods This is a retrospective analysis of two separate sets of prospectively collected trauma registry data of Al-Ain Hospital. Data were collected over two periods: from March 2003 to March 2006 and from January 2014 to December 2017. Demography, injury mechanism, injury location, and clinical outcomes of 2573 trauma patients in the first period were compared with 3519 patients in the second period. Results Trauma incidence decreased by 38.2% in Al-Ain City over the last 10 years. Trauma to females, UAE nationals, and the geriatric population significantly increased over time (p < 0.0001, Fisher’s exact test for each). Falls on the same level significantly increased over time, while road traffic collisions and falls from height significantly decreased over time (p < 0.0001, Fisher’s exact test for each). Mortality significantly decreased over time (2.3% compared with 1%, p < 0.0001, Fisher’s exact test). Conclusions Developments in the trauma system of our city have reduced mortality in hospitalized trauma patients by 56% despite an increased severity of injury. Furthermore, the injury incidence in our city decreased by 38.2% over the last decade. This was mainly in road traffic collisions and work-related injuries. Nevertheless, falls on the same level in the geriatric population continue to be a significant problem that needs to be addressed.
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Brochhausen M, Ball JW, Sanddal ND, Dodd J, Braun N, Bost S, Utecht J, Winchell RJ, Sexton KW. Collecting data on organizational structures of trauma centers: the CAFE web service. Trauma Surg Acute Care Open 2020; 5:e000473. [PMID: 32789188 PMCID: PMC7394144 DOI: 10.1136/tsaco-2020-000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background During the past several decades, the American College of Surgeons has led efforts to standardize trauma care through their trauma center verification process and Trauma Quality Improvement Program. Despite these endeavors, great variability remains among trauma centers functioning at the same level. Little research has been conducted on the correlation between trauma center organizational structure and patient outcomes. We are attempting to close this knowledge gap with the Comparative Assessment Framework for Environments of Trauma Care (CAFE) project. Methods Our first action was to establish a shared terminology that we then used to build the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT). OOSTT underpins the web-based CAFE questionnaire that collects detailed information on the particular organizational attributes of trauma centers and trauma systems. This tool allows users to compare their organizations to an aggregate of other organizations of the same type, while collecting their data. Results In collaboration with the American College of Surgeons Committee on Trauma, we tested the system by entering data from three trauma centers and four trauma systems. We also tested retrieval of answers to competency questions. Discussion The data we gather will be made available to public health and implementation science researchers using visualizations. In the next phase of our project, we plan to link the gathered data about trauma center attributes to clinical outcomes.
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Affiliation(s)
- Mathias Brochhausen
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Jane W Ball
- American College of Surgeons, Chicago, Illinois, USA
| | | | - Jimm Dodd
- American College of Surgeons, Chicago, Illinois, USA
| | - Naomi Braun
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Sarah Bost
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Joseph Utecht
- Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Validation of the PRESTO score in injured children in a South-African quaternary trauma center. J Pediatr Surg 2020; 55:1245-1248. [PMID: 31515111 DOI: 10.1016/j.jpedsurg.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Pediatric RESuscitation and Trauma Outcome (PRESTO) model was developed for standardized risk-adjustment in pediatric trauma and is adapted to low-resource settings. It includes easily-accessible demographic and physiologic variables that are available at point of care in virtually any setting. The purpose of this study was to evaluate the PRESTO model's ability to predict in-hospital mortality in a South African pediatric trauma unit by comparing it to the widely used Injury Severity Score (ISS). METHODS Data prospectively collected between 2007 and 2017 in the Inkosi Albert Luthuli Central Hospital Trauma Registry were retrospectively reviewed. Injured children younger than 14 years were included if they were admitted to hospital or died as a result of their injury. We excluded patients with minor injuries who were treated and discharged home and patients with incomplete hospital disposition data. Receiver-Operating Characteristic (ROC) curves were constructed for PRESTO and ISS, and the areas under the curve (AUCs) were compared using Delong's test. The sensitivity and specificity of PRESTO were calculated at different prognostic threshold values identified through literature review. RESULTS We identified 419 patients; 67 died in hospital (16%). The AUCs for PRESTO and ISS were 0.82 (95% confidence interval CI [0.76-0.87]) and 0.75 (CI [0.68-0.81]), respectively. This difference trended towards statistical significance (p = 0.07). Using the optimal threshold of 0.13 described in the original publication, PRESTO had a 97% sensitivity and 37% specificity, while a threshold of 0.50 yielded 90% sensitivity and 54% specificity. The mean predicted probability of in-hospital death among patients who died was 0.79. Using this value as a threshold yielded the 57% sensitivity and 85% specificity. CONCLUSION This analysis has demonstrated the validity of the PRESTO model for in-hospital mortality prediction for pediatric trauma patients in the setting of a dedicated high-complexity trauma unit in a South African trauma referral center. LEVEL OF EVIDENCE Level III: Case-control.
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Kang WS, Jo YG, Park YC. Quality Improvement of Damage Control Laparotomy: Impact of the Establishment of a Single Korean Regional Trauma Center. World J Surg 2020; 43:2814-2821. [PMID: 31297581 DOI: 10.1007/s00268-019-05083-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Damage control laparotomy (DCL) is a lifesaving technique to minimize the lethal triad of coagulopathy, hypothermia, and acidosis. The government has nominated and supported our center as one of the regional trauma centers of South Korea since 2014. This study aimed to investigate the improving outcomes of patients undergoing DCL before and after the establishment of the trauma center. METHOD The period from January 2011 to December 2017 was divided into pre-trauma center (pre-TC) (2011-2013) and trauma center (TC) (2014-2017) periods. Multivariable logistic regression was performed to identify the risk factors and risk-adjusted cumulative sum (RA-CUSUM), and graphs were used to monitor the change in mortality. RESULT Of the 485 patients who underwent trauma laparotomy, DCL was performed for 119 patients (24.5%). The operation time (99 vs. 80 min, p = 0.022), time from admission to operation (125 vs. 112 min, p = 0.010), time from admission to first treatment (119 vs. 99 min, p = 0.004), and time from admission to first transfusion (70 vs. 52 min, p = 0.009) were significantly shortened in the TC period. The ratio of plasma to packed red blood cells in massive transfusions (≥PRBCs 10 units within the first 24 h) was significantly increased in the TC period (0.56 vs. 0.72, p = 0.004). RA-CUSUM curves revealed that the risk-adjusted 30-day mortality improved and then plateaued in the TC period. CONCLUSION After the implementation of a trauma center, more prompt intervention and damage control resuscitation could be achieved. Moreover, risk-adjusted mortality of DCL was improved.
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Affiliation(s)
- Wu Seong Kang
- Division of Trauma Surgery, Department of Surgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Dong-gu, Gwangju, Korea.,Department of Trauma Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Young Goun Jo
- Division of Trauma Surgery, Department of Surgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Dong-gu, Gwangju, Korea.
| | - Yun Chul Park
- Division of Trauma Surgery, Department of Surgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Dong-gu, Gwangju, Korea
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Lapointe L, Lavallee-Bourget MH, Pichard-Jolicoeur A, Turgeon-Pelchat C, Fleet R. Impact of telemedicine on diagnosis, clinical management and outcomes in rural trauma patients: A rapid review. CANADIAN JOURNAL OF RURAL MEDICINE 2020; 25:31-40. [PMID: 31854340 DOI: 10.4103/cjrm.cjrm_8_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Rural trauma patients are at increased risk of morbidity and mortality compared to trauma patients treated in urban facilities. Factors contributing to this disparity include differences in resource availability and increased time to definitive treatment for rural patients. Telemedicine can improve the early management of these patients by enabling rural providers to consult with trauma specialists at urban centres. The purpose of this study was to assess the impact of telemedicine utilisation on the diagnosis, clinical management and outcomes of rural trauma patients. Materials and Methods A rapid review of the literature was performed using the concepts 'trauma', 'rural' and 'telemedicine'. Fifteen electronic databases were searched from inception to 29th June 2018. Manual searches were also conducted in relevant systematic reviews, key journals and bibliographies of included studies. Results The literature search identified 187 articles, of which 8 articles were included in the review. All 8 studies reported on clinical management, while the impact of telemedicine use on diagnosis and outcomes was reported in 4 and 5 studies, respectively. Study findings suggest that the use of telemedicine may improve patient diagnosis, streamline the process of transferring patients and reduce length of stay. Use of telemedicine had minimal impact on mortality and complications in rural trauma patients. Conclusions The evidence identified by this rapid review suggests that telemedicine may improve the diagnosis, management and outcomes of rural trauma patients. Further research is required to validate these findings by performing large and well-designed studies in rural areas, ideally as randomised clinical trials.
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Affiliation(s)
- Luc Lapointe
- Research Chair in Emergency Medicine, CISSS Chaudière-Appalaches, Laval University, Centre De Recherche Du CISSS Chaudière-Appalaches Lévis; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Marie-Helene Lavallee-Bourget
- Research Chair in Emergency Medicine, CISSS Chaudière-Appalaches, Laval University, Centre De Recherche Du CISSS Chaudière-Appalaches Lévis, Canada
| | - Alexia Pichard-Jolicoeur
- Research Chair in Emergency Medicine, CISSS Chaudière-Appalaches, Laval University, Centre De Recherche Du CISSS Chaudière-Appalaches Lévis, Canada
| | - Catherine Turgeon-Pelchat
- Research Chair in Emergency Medicine, CISSS Chaudière-Appalaches, Laval University, Centre De Recherche Du CISSS Chaudière-Appalaches Lévis, Canada
| | - Richard Fleet
- Research Chair in Emergency Medicine, CISSS Chaudière-Appalaches, Laval University, Centre De Recherche Du CISSS Chaudière-Appalaches Lévis; Department of Family and Emergency Medicine, Laval University; Centre De Recherche Sur Les Soins Et Services De Première Ligne Université Laval, Québec, Canada
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Babu BV, Vishwanathan K, Ramesh A, Gupta A, Tiwari S, Palatty BU, Sharma Y. Trauma Care in India: Capacity Assessment Survey From Five Centers. J Surg Res 2020; 252:156-168. [PMID: 32278970 DOI: 10.1016/j.jss.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/03/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND India is in the process of strengthening the trauma care system, and assessment of the current situation using standard guidelines has immense use. This study reports the status of trauma care facilities in India, with a broad framework of guidelines for essential trauma care by the World Health Organization. MATERIALS AND METHODS This study is part of a multicentric intervention study to standardize structured trauma care services in five Indian cities. Thirty trauma care facilities (five level I, 10 level II, and 15 level III facilities) were included. Data on the availability of equipment and manpower were collected. Availability of knowledge + skills and equipment + supplies was assessed based on the guidelines for essential trauma care by World Health Organization. RESULTS There is almost 100% availability of services and equipment in level I hospitals, but availability varied between 50% and 100% at level II facilities. Very fewer number of services are available at level III facilities. Inadequacy of equipment is reported in level II and III facilities. Only level I facilities have required human resources. Availability of resources in terms of knowledge and equipment of different skills indicated that overall optimal level is observed in level I hospitals. Level II facilities are more deficient in nursing and paramedic staff, and level III facilities reported deficiencies in all categories. CONCLUSIONS A significant imbalance between recommended resources and the resources that are available in the trauma care facilities was noted. Hence, the study warrants urgent strengthening of trauma care facilities, particularly of level II and III facilities.
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Affiliation(s)
- Bontha V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India.
| | - Karthik Vishwanathan
- Department of Orthopaedics, Pramukhswami Medical College, Karamsad, Anand, India
| | - Aruna Ramesh
- Department of Emergency Medicine, M.S. Ramaiah Medical College, Bengaluru, India
| | - Amit Gupta
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Tiwari
- Department of General Surgery, King George's Medical University, Lucknow, India
| | - Babu U Palatty
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, India
| | - Yogita Sharma
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
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Salvo F, Luppi F, Lucchesi DM, Canovi S, Franchini S, Polese A, Santi F, Trabucco L, Fasano T, Ferrari AM. Serum Copeptin levels in the emergency department predict major clinical outcomes in adult trauma patients. BMC Emerg Med 2020; 20:14. [PMID: 32093639 PMCID: PMC7041089 DOI: 10.1186/s12873-020-00310-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early prognostication in trauma patients is challenging, but particularly important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital admission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission. METHODS This single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria Nuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency Department (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised Trauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality. RESULTS One hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March 2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances were recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying patients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016). Comparable results were observed in a subgroup of patients with RTS 7.84. CONCLUSIONS In a heterogeneous group of trauma patients, a single copeptin determination at the time of ED admission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma, hospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and emergency surgery. These results, if confirmed, may support a role for copeptin during early management of trauma patients.
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Affiliation(s)
- Fulvio Salvo
- Department of Emergency Medicine Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy. .,Present address: Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
| | - Francesco Luppi
- Department of Emergency Medicine Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Davide M Lucchesi
- Department of Emergency Medicine Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Simone Canovi
- Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Stefano Franchini
- Emergency Department, Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy
| | - Alessandra Polese
- Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Francesca Santi
- Department of Emergency Medicine Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Laura Trabucco
- Department of Emergency Medicine Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Tommaso Fasano
- Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Anna Maria Ferrari
- Department of Emergency Medicine Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
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Varghese M. Prehospital trauma care evolution, practice and controversies: need for a review. Int J Inj Contr Saf Promot 2020; 27:69-82. [DOI: 10.1080/17457300.2019.1708409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mathew Varghese
- Department of Orthopaedic Surgery, St Stephen’s Hospital, Delhi, India
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Hietbrink F, Houwert RM, van Wessem KJP, Simmermacher RKJ, Govaert GAM, de Jong MB, de Bruin IGJ, de Graaf J, Leenen LPH. The evolution of trauma care in the Netherlands over 20 years. Eur J Trauma Emerg Surg 2019; 46:329-335. [PMID: 31760466 PMCID: PMC7113214 DOI: 10.1007/s00068-019-01273-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential
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Affiliation(s)
- Falco Hietbrink
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Roderick M Houwert
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Karlijn J P van Wessem
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rogier K J Simmermacher
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Geertje A M Govaert
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mirjam B de Jong
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ivar G J de Bruin
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Johan de Graaf
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Loek P H Leenen
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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