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de Malleray H, de Lesquen H, Boddaert G, Raux M, Lefrançois V, Delhaye N, Ponsin P, Cordorniu A, Floch T, Bounes F, Gaertner E, Hardy A, Bordes J, Meaudre É, Cardinale M. French practice of emergency resuscitative thoracotomy. A study based on the Traumabase Registry. J Visc Surg 2024:S1878-7886(24)00095-X. [PMID: 39097430 DOI: 10.1016/j.jviscsurg.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
AIM OF THE STUDY Emergency resuscitative thoracotomy (ERT) has been described as a potentially life-saving procedure for trauma patients who have been admitted in refractory shock or with recent loss of sign of life (SOL). This nationwide registry analysis aimed to describe the French practice of ERT. PATIENTS AND METHODS From 2015 to 2021, all severe trauma patients who underwent ERT were extracted from the TraumaBase→ registry. Demographic data, prehospital management and in-hospital outcomes were recorded to evaluate predictors of success-to rescue after ERT at 24-hour and 28-day. RESULTS Only 10/26 Trauma centers have an effective practice of ERT, three of them perform more than 1 ERT/year. Sixty-six patients (74% male, 49/66) with a median age of 37 y/o [26-51], mostly with blunt trauma (52%, 35/66) were managed with ERT. The median pre-hospital time was 64mins [45-89]. At admission, the median injury severity score was 35 [25-48], and 51% (16/30) of patients have lost SOL. ERT was associated with a massive transfusion protocol including 8 RBCs [6-13], 6 FFPs [4-10], and 0 PCs [0-1] in the first 6h. The overall success-to-rescue after ERT at 24-h and 28-d were 27% and 15%, respectively. In case of refractory shock after penetrating trauma, survival was 64% at 24-hours and 47% at 28-days. CONCLUSIONS ERT integrated into the trauma protocol remains a life-saving procedure that appears to be underutilized in France, despite significant success-to-rescue observed by trained teams for selected patients.
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Affiliation(s)
- Hilaire de Malleray
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France.
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care Medicine, AP-HP-Sorbonne University, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Valentin Lefrançois
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Caen, France.
| | - Nathalie Delhaye
- Department of Anesthesiology and Critical Care Medicine, European Hospital Georges Pompidou, AP-HP, Paris, France.
| | - Pauline Ponsin
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France.
| | - Anaïs Cordorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Beaujon, France.
| | - Thierry Floch
- Department of Anesthesiology and Critical Care Medicine, Reims University Hospital, Reims, France.
| | - Fanny Bounes
- Department of Anesthesiology and Critical Care Toulouse University Hospital, Toulouse, France.
| | - Elisabeth Gaertner
- Department of Anesthesiology and Critical Care, Louis Pasteur Hospital, Colmar, France.
| | - Alexia Hardy
- Department of Anesthesiology and Critical Care, Valenciennes Hospital, Beaujon, France.
| | - Julien Bordes
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Éric Meaudre
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Michael Cardinale
- Department of Anesthesiology and Critical Care Medicine, Sainte Anne Military Teaching Hospital, Toulon, France.
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Codorniu A, Charbit E, Werner M, James A, Hanouz JL, Jost D, Severin A, Lang E, Pottecher J, Favreau M, Weiss E, Abback PS, Moyer JD. Comparison of mannitol and hypertonic saline solution for the treatment of suspected brain herniation during prehospital management of traumatic brain injury patients. Eur J Emerg Med 2024; 31:287-293. [PMID: 38691014 DOI: 10.1097/mej.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND IMPORTANCE Occurrence of mydriasis during the prehospital management of traumatic brain injury (TBI) may suggest severe intracranial hypertension (ICH) subsequent to brain herniation. The initiation of hyperosmolar therapy to reduce ICH and brain herniation is recommended. Whether mannitol or hypertonic saline solution (HSS) should be preferred is unknown. OBJECTIVES The objective of this study is to assess whether HSS, compared with mannitol, is associated with improved survival in adult trauma patients with TBI and mydriasis. DESIGN/SETTING AND PARTICIPANTS A retrospective observational cohort study using the French Traumabase national registry to compare the ICU mortality of patients receiving either HSS or mannitol. Patients aged 16 years or older with moderate to severe TBI who presented with mydriasis during prehospital management were included. OUTCOME MEASURES AND ANALYSIS We performed propensity score matching on a priori selected variables [i.e. age, sex and initial Coma Glasgow Scale (GCS)] with a ratio of 1 : 3 to ensure comparability between the two groups. The primary outcome was ICU mortality. The secondary outcomes were regression of pupillary abnormality during prehospital management, pulsatility index and diastolic velocity on transcranial Doppler within 24 h after TBI, early ICU mortality (within 48 h), ICU and hospital length of stay. RESULTS Of 31 579 patients recorded in the registry between 2011 and 2021, 1417 presented with prehospital mydriasis and were included: 1172 (82.7%) received mannitol and 245 (17.3%) received HSS. After propensity score matching, 720 in the mannitol group matched 240 patients in the HSS group. Median age was 41 years [interquartile ranges (IQR) 26-60], 1058 were men (73%) and median GCS was 4 (IQR 3-6). No significant difference was observed in terms of characteristics and prehospital management between the two groups. ICU mortality was lower in the HSS group (45%) than in the mannitol group (54%) after matching [odds ratio (OR) 0.68 (0.5-0.9), P = 0.014]. No differences were identified between the groups in terms of secondary outcomes. CONCLUSION In this propensity-matched observational study, the prehospital osmotherapy with HSS in TBI patients with prehospital mydriasis was associated with a lower ICU mortality compared to osmotherapy with mannitol.
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Affiliation(s)
- Anais Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris
| | - Emilie Charbit
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris
| | - Marie Werner
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Saclay, Université Paris Saclay, Le Kremlin Bicêtre
| | - Arthur James
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la cote de Nacre, Caen
| | - Daniel Jost
- Emergency Medical Department, Fire Brigade of Paris
| | - Armelle Severin
- SAMU des Hauts-de-Seine - SMUR Raymond Poincaré, Raymond Poincaré Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris (APHP)
| | - Elodie Lang
- Department of Anaesthesia and Critical Care, AP-HP, Hôpital Européen Georges Pompidou, Paris Cité University, Paris
| | - Julien Pottecher
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Fédération de Médecine Translationnelle de Strasbourg, ER 3072, Strasbourg University Hospital, Strasbourg
| | - Malory Favreau
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris
| | - Paer Selim Abback
- Department of Anesthesiology and Critical Care Medicine, CHU Tours, Tours University Hospital, Tours, France
| | - Jean-Denis Moyer
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la cote de Nacre, Caen
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3
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Duclos G, Heireche F, Siroutot M, Delamarre L, Sartorius MA, Mergueditchian C, Velly L, Carvelli J, Bordais A, Pilarczyk E, Leone M. The association between regional guidelines compliance and mortality in severe trauma patients: an observational, retrospective study. Eur J Emerg Med 2024; 31:208-215. [PMID: 38265763 DOI: 10.1097/mej.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND IMPORTANCE Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients. OBJECTIVES The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients. DESIGN, SETTINGS AND PARTICIPANTS We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items. OUTCOME MEASURES AND ANALYSIS The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24. MAIN RESULTS A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)]. CONCLUSION Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.
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Affiliation(s)
- Gary Duclos
- Aix- Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, Hôpital Nord
| | - Fouzia Heireche
- Aix-Marseille Université, Service d'Aide Médicale d'Urgence 13, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone, Marseille
| | | | - Louis Delamarre
- Aix- Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, Hôpital Nord
| | - Max-Antoine Sartorius
- Aix-Marseille Université, Service des urgences, Assistance Publique Hôpitaux de Marseille, hôpital Nord
| | - Celine Mergueditchian
- Aix-Marseille Université, Service des urgences, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone
| | - Lionel Velly
- Aix-Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone
| | - Julien Carvelli
- Aix-Marseille Université, Médecine Intensive et Réanimation, Unité de Réanimation des Urgences, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone, Marseille, France
| | - Aurelia Bordais
- Aix-Marseille Université, Service des urgences, Assistance Publique Hôpitaux de Marseille, hôpital Nord
| | - Estelle Pilarczyk
- Aix-Marseille Université, Service d'Aide Médicale d'Urgence 13, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone, Marseille
| | - Marc Leone
- Aix- Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, Hôpital Nord
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Bouzat P. Standardizing categorization of major trauma patients in France: A position paper from the GITE Network. Anaesth Crit Care Pain Med 2024; 43:101345. [PMID: 38272354 DOI: 10.1016/j.accpm.2024.101345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Pierre Bouzat
- Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043 Grenoble, France.
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5
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Aarab Y, Debourdeau T, Garnier F, Capdevila M, Monet C, De Jong A, Capdevila X, Charbit J, Dagod G, Pensier J, Jaber S. Management and outcomes of COVID-19 patients admitted in a newly created ICU and an expert ICU, a retrospective observational study. Anaesth Crit Care Pain Med 2024; 43:101321. [PMID: 37944861 DOI: 10.1016/j.accpm.2023.101321] [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: 10/06/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic abruptly increased the inflow of patients requiring intensive care units (ICU). French health institutions responded by a twofold capacity increase with temporary upgraded beds, supplemental beds in pre-existing ICUs, or newly created units (New-ICU). We aimed to compare outcomes according to admission in expert pre-existing ICUs or in New-ICU. METHODS This multicenter retrospective observational study was conducted in two 20-bed expert ICUs of a University Hospital (Expert-ICU) and in one 16-bed New-ICU in a private clinic managed respectively by 3 and 2 physicians during daytime and by one physician during the night shift. All consecutive adult patients with COVID-19-related acute hypoxemic respiratory failure admitted after centralized regional management by a dedicated crisis cell were included. The primary outcome was 180-day mortality. Propensity score matching and restricted cubic spline for predicted mortality over time were performed. RESULTS During the study period, 165 and 176 patients were enrolled in Expert-ICU and New-ICU respectively, 162 (98%) and 157 (89%) patients were analyzed. The unadjusted 180-day mortality was 30.8% in Expert-ICU and 28.7% in New-ICU, (log-rank test, p = 0.7). After propensity score matching, 123 pairs (76 and 78%) of patients were matched, with no significant difference in mortality (32% vs. 32%, OR 1.00 [0.89; 1.12], p = 1). Adjusted predicted mortality decreased over time (p < 0.01) in both Expert-ICU and New-ICU. CONCLUSIONS In COVID-19 patients with acute hypoxemic respiratory failure, hospitalization in a new ICU was not associated with mortality at day 180.
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Affiliation(s)
- Yassir Aarab
- Intensive Care Unit, Clinique Saint-Jean Sud de France, Montpellier, France; Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France.
| | - Theodore Debourdeau
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Fanny Garnier
- Intensive Care Unit, Clinique Saint-Jean Sud de France, Montpellier, France
| | - Mathieu Capdevila
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Clément Monet
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Audrey De Jong
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Jonathan Charbit
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Geoffrey Dagod
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Joris Pensier
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
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Piliuk K, Tomforde S. Artificial intelligence in emergency medicine. A systematic literature review. Int J Med Inform 2023; 180:105274. [PMID: 37944275 DOI: 10.1016/j.ijmedinf.2023.105274] [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: 07/25/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
Motivation and objective: Emergency medicine is becoming a popular application area for artificial intelligence methods but remains less investigated than other healthcare branches. The need for time-sensitive decision-making on the basis of high data volumes makes the use of quantitative technologies inevitable. However, the specifics of healthcare regulations impose strict requirements for such applications. Published contributions cover separate parts of emergency medicine and use disparate data and algorithms. This study aims to systematize the relevant contributions, investigate the main obstacles to artificial intelligence applications in emergency medicine, and propose directions for further studies. METHODS The contributions selection process was conducted with systematic electronic databases querying and filtering with respect to established exclusion criteria. Among the 380 papers gathered from IEEE Xplore, ACM Digital Library, Springer Library, ScienceDirect, and Nature databases 116 were considered to be a part of the survey. The main features of the selected papers are the focus on emergency medicine and the use of machine learning or deep learning algorithms. FINDINGS AND DISCUSSION The selected papers were classified into two branches: diagnostics-specific and triage-specific. The former ones are focused on either diagnosis prediction or decision support. The latter covers such applications as mortality, outcome, admission prediction, condition severity estimation, and urgent care prediction. The observed contributions are highly specialized within a single disease or medical operation and often use privately collected retrospective data, making them incomparable. These and other issues can be addressed by creating an end-to-end solution based on human-machine interaction. CONCLUSION Artificial intelligence applications are finding their place in emergency medicine, while most of the corresponding studies remain isolated and lack higher generalization and more sophisticated methodology, which can be a matter of forthcoming improvements.
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Affiliation(s)
| | - Sven Tomforde
- Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany
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7
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Predictive factors of non-operative management failure in 494 blunt liver injuries: a multicenter retrospective study. Updates Surg 2022; 74:1901-1913. [DOI: 10.1007/s13304-022-01367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
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8
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International Perspectives of Prehospital and Hospital Trauma Services: A Literature Review. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030037] [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
Background: Evidence suggests that reductions in the incidence in trauma observed in some countries are related to interventions including legislation around road and vehicle safety measures, public behaviour change campaigns, and changes in trauma response systems. This study aims to briefly review recent refereed and grey literature about prehospital and hospital trauma care services in different regions around the world and describe similarities and differences in identified systems to demonstrate the diversity of characteristics present. Methods: Articles published between 2000 and 2020 were retrieved from MEDLINE and EMBASE. Since detailed comparable information was lacking in the published literature, prehospital emergency service providers’ annual performance reports from selected example countries or regions were reviewed to obtain additional information about the performance of prehospital care. Results: The review retained 34 studies from refereed literature related to trauma systems in different regions. In the U.S. and Canada, the trauma care facilities consisted of five different levels of trauma centres ranging from Level I to Level IV and Level I to Level V, respectively. Hospital care and organisation in Japan is different from the U.S. model, with no dedicated trauma centres; however, patients with severe injury are transported to university hospitals’ emergency departments. Other similarities and differences in regional examples were observed. Conclusions: The refereed literature was dominated by research from developed countries such as Australia, Canada, and the U.S., which all have organised trauma systems. Many European countries have implemented trauma systems between the 1990s and 2000s; however, some countries, such as France and Greece, are still forming an integrated system. This review aims to encourage countries with immature trauma systems to consider the similarities and differences in approaches of other countries to implementing a trauma system.
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9
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Ageron FX, Porteaud J, Evain JN, Millet A, Greze J, Vallot C, Levrat A, Mortamet G, Bouzat P. Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis. World J Emerg Surg 2021; 16:1. [PMID: 33413465 PMCID: PMC7791780 DOI: 10.1186/s13017-020-00345-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. Methods This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. Results A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3–10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8–5.4]). Conclusions In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.
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Affiliation(s)
- François-Xavier Ageron
- RENAU Northern French Alps Emergency Network, Public Health Department, Annecy Hospital, F-74000, Annecy, France
| | - Jordan Porteaud
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Jean-Noël Evain
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Anne Millet
- Department of Pediatric Care, Pediatric Intensive Care Unit, Grenoble University Hospital, F-38000, Grenoble, France
| | - Jules Greze
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Cécile Vallot
- RENAU Northern French Alps Emergency Network, Public Health Department, Annecy Hospital, F-74000, Annecy, France
| | - Albrice Levrat
- Department of Intensive Care, Annecy Hospital, F-74000, Annecy, France
| | - Guillaume Mortamet
- Department of Pediatric Care, Pediatric Intensive Care Unit, Grenoble University Hospital, F-38000, Grenoble, France.,Grenoble Alps University, F-38000, Grenoble, France
| | - Pierre Bouzat
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France. .,Grenoble Alps University, F-38000, Grenoble, France. .,Grenoble Alpes Trauma Centre, Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France.
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10
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French civilian surgical expertise still inadequately prepared for mass casualties 3 years after major terror attacks in Paris (2015) and Nice (2016). J Trauma Acute Care Surg 2021; 89:S26-S31. [PMID: 32044874 DOI: 10.1097/ta.0000000000002606] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a nonselected population of practicing French surgeons. METHODS A questionnaire was sent between July and December 2017 to French students and practicing surgeons, using the French Surgical Colleges' mailing lists. Items analyzed included education, training, interest and clinical activity in trauma care and damage-control surgery (DCS). RESULTS 622 questionnaires were analyzed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in Level I trauma centers (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of 'interest in trauma care' was 8/10. Factors associated with a higher score were being a resident doctor (p = 0.01), a digestive surgeon (p = 0.0013), in the military (p = 1,71 × 10) and working in TC1 (p = 0.034). The mean "DCS techniques knowledge" score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively, p = 0.0007 and p = 0.001) and in the military (respectively p = 1.74 × 10 and p = 3.94 × 10). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons. CONCLUSION French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate. LEVEL OF EVIDENCE Level III, Study Type Survey.
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11
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Bouzat P, Thony F, Arvieux C. Management of splenic injury after blunt abdominal trauma: insights from the SPLASH trial. Anaesth Crit Care Pain Med 2020; 39:747-748. [PMID: 33122040 DOI: 10.1016/j.accpm.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pierre Bouzat
- Grenoble Alps Trauma centre, Department of anaesthesiology and intensive care medicine, Grenoble-Alpes University Hospital, F-38000, Grenoble, France.
| | - Frédéric Thony
- Department of Imaging and Interventional Radiology, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Catherine Arvieux
- Department of General and Digestive Surgery, Grenoble-Alpes University Hospital, 38000 Grenoble, France
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12
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Stonko DP, Guillamondegui OD, Fischer PE, Dennis BM. Artificial intelligence in trauma systems. Surgery 2020; 169:1295-1299. [PMID: 32921479 DOI: 10.1016/j.surg.2020.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Local trauma care and regional trauma systems are data-rich environments that are amenable to machine learning, artificial intelligence, and big-data analysis mechanisms to improve timely access to care, to measure outcomes, and to improve quality of care. Pilot work has been done to demonstrate that these methods are useful to predict patient flow at individual centers, so that staffing models can be adapted to match workflow. Artificial intelligence has also been proven useful in the development of regional trauma systems as a tool to determine the optimal location of a new trauma center based on trauma-patient geospatial injury data and to minimize response times across the trauma network. Although the utility of artificial intelligence is apparent and proven in small pilot studies, its operationalization across the broader trauma system and trauma surgery space has been slow because of cost, stakeholder buy-in, and lack of expertise or knowledge of its utility. Nevertheless, as new trauma centers or systems are developed, or existing centers are retooled, machine learning and sophisticated analytics are likely to be important components to help facilitate decision-making in a wide range of areas, from determining bedside nursing and provider ratios to determining where to locate new trauma centers or emergency medical services teams.
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Affiliation(s)
- David P Stonko
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Oscar D Guillamondegui
- Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Peter E Fischer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Bradley M Dennis
- Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Vanderbilt University Medical Center, Nashville, TN.
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Schneider AG, Duranteau J, Bouzat P. Acute kidney injury and severe trauma: A complex interplay. Anaesth Crit Care Pain Med 2020; 39:493-494. [PMID: 32653547 DOI: 10.1016/j.accpm.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Antoine Guillaume Schneider
- Service de Médecine Intensive Adulte, Centre Hospitalier et Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Suisse.
| | - Jacques Duranteau
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, France
| | - Pierre Bouzat
- Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Bouzat P, Ageron FX, Thomas M, Vallot C, Hautefeuille S, Schilte C, Payen JF. Modeling the Influence of Age on Neurological Outcome and Quality of Life One Year after Traumatic Brain Injury: A Prospective Multi-Center Cohort Study. J Neurotrauma 2019; 36:2506-2512. [DOI: 10.1089/neu.2019.6432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pierre Bouzat
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
- INSERM 1216, Grenoble Neuroscience Institute, Grenoble Alps University, Grenoble, France
| | - François-Xavier Ageron
- Public Health Department, RENAU Northern French Alps Emergency Network, Annecy Hospital, Annecy, France
- Department of Intensive Care, Annecy Hospital, Annecy, France
| | - Marine Thomas
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
| | - Cécile Vallot
- Public Health Department, RENAU Northern French Alps Emergency Network, Annecy Hospital, Annecy, France
- Department of Intensive Care, Annecy Hospital, Annecy, France
| | | | - Clotilde Schilte
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
| | - Jean-François Payen
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
- INSERM 1216, Grenoble Neuroscience Institute, Grenoble Alps University, Grenoble, France
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Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury. Intensive Care Med 2019; 45:1231-1240. [PMID: 31418059 DOI: 10.1007/s00134-019-05724-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The majority of terrorist acts are carried out by explosion or shooting. The objective of this study was first, to describe the management implemented to treat a large number of casualties and their flow together with the injuries observed, and second, to compare these resources according to the mechanism of trauma. METHODS This retrospective cohort study collected medical data from all casualties of the attacks on November 13th 2015 in Paris, France, with physical injuries, who arrived alive at any hospital within the first 24 h after the events. Casualties were divided into two groups: explosion injuries and gunshot wounds. RESULTS 337 casualties were admitted to hospital, 286 (85%) from gunshot wounds and 51 (15%) from explosions. Gunshot casualties had more severe injuries and required more in-hospital resources than explosion casualties. Emergency surgery was required in 181 (54%) casualties and was more frequent for gunshot wounds than explosion injuries (57% vs. 35%, p < 0·01). The types of main surgery needed and their delay following hospital admission were as follows: orthopedic [n = 107 (57%); median 744 min]; general [n = 27 (15%); 90 min]; vascular [n = 19 (10%); median 53 min]; thoracic [n = 19 (10%); 646 min]; and neurosurgery [n = 4 (2%); 198 min]. CONCLUSION The resources required to deal with a terrorist attack vary according to the mechanism of trauma. Our study provides a template to estimate the proportion of various types of surgical resources needed overall, as well as their time frame in a terrorist multisite and multitype attack. FUNDING Assistance Publique-Hôpitaux de Paris.
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Speckle tracking quantification of lung sliding for the diagnosis of pneumothorax: a multicentric observational study. Intensive Care Med 2019; 45:1212-1218. [PMID: 31359081 DOI: 10.1007/s00134-019-05710-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/19/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Lung ultrasound is used for the diagnosis of pneumothorax, based on lung sliding abolition which is a qualitative and operator-dependent assessment. Speckle tracking allows the quantification of structure deformation over time by analysing acoustic markers. We aimed to test the ability of speckle tracking technology to quantify lung sliding in a selected cohort of patients and to observe how the technology may help the process of pneumothorax diagnosis. METHODS We performed retrospectively a pleural speckle tracking analysis on ultrasound loops from patients with pneumothorax. We compared the values measured by two observers from pneumothorax side with contralateral normal lung side. The receiver operating characteristic (ROC) curve was constructed to evaluate the performance of maximal pleural strain to detect the lung sliding abolition. Diagnosis performance and time to diagnosis between B-Mode and speckle tracking technology were compared from a third blinded observer. RESULTS We analysed 104 ultrasound loops from 52 patients. The area under the ROC curve of the maximal pleural strain value to identify lung sliding abolition was 1.00 [95%CI 1.00; 1.00]. Specificity was 100% [95%CI 93%; 100%] and sensitivity was 100% [95%CI 93%; 100%] with the best cut-off of 4%. Over 104 ultrasound loops, the blinded observer made two errors with B-Mode and none with speckle tracking. The median diagnosis time was 3 [2-5] seconds for B-Mode versus 2 [1-2] seconds for speckle tracking (p = 0.001). CONCLUSION Speckle tracking technology allows lung sliding quantification and detection of lung sliding abolition in case of pneumothorax on selected ultrasound loops.
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Maegele M, Galvagno SM. Implementation of trauma systems: Not inventing the wheel over and over again! Anaesth Crit Care Pain Med 2019; 38:107-108. [PMID: 30742928 DOI: 10.1016/j.accpm.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marc Maegele
- Department of Traumatology and Orthopaedic Surgery Cologne-Merheim Medical Centre (CMMC) Institute for Research in Operative Medicine (IFOM) University Witten-Herdecke (UWH) Ostmerheimerstr. 200 D-51109 Köln, Germany.
| | - Samuel M Galvagno
- School of Medicine R Adams Cowley Shock Trauma Center Department of Anesthesiology and Program in Trauma Baltimore, 21201 Baltimore, United States of America.
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Bouzat P. Construire une filière de soins pour les traumatismes graves à l’échelle nationale : un groupe d’experts se positionne. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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