1
|
Naude C, Bujon C, Boussen S, Serre T, Bélot F. Comparison of kinetic changes during helicopter medical evacuations: civilian versus military flights. Inj Prev 2024; 30:239-245. [PMID: 38050041 DOI: 10.1136/ip-2023-044972] [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: 05/16/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Helicopter evacuation is crucial for providing medical care to casualties. Previous civilian studies have demonstrated that air transport can enhance survival rates compared with ground transport. However, there has been limited research on specific accelerations during helicopter flights, particularly in military flights. This study aims to analyse and compare the accelerations endured during civilian and military helicopter evacuations. METHODS Accelerations were recorded during evacuation flights from the site of injury to the first medical responders in civilian helicopter EC135 T1, and military Puma SA.330 and Caiman NH90 TTH helicopters. The research investigated global acceleration and compared acceleration distributions along the vertical, lateral and longitudinal axes. A specific comparative study of the take-off phases was also performed. RESULTS The analysis showed that vertical loads caused the most extreme accelerations for all types of helicopter but these extreme accelerations were rare and lasted for less than 1 s. Military flights show similar acceleration intensities to civilian flights, but accelerations are higher during short periods of the take-off phase. CONCLUSIONS The findings suggest that helicopter evacuations during military operations are as safe as civilian evacuations and highlight the importance of patient positioning in the aircraft. However, further research should investigate the haemodynamic response to accelerations experienced during actual evacuation flights.
Collapse
Affiliation(s)
- Claire Naude
- Université Gustave Eiffel - Campus Méditerranée, Salon de Provence, France
| | - Cécile Bujon
- Hôpital d'Instruction des Armées, Marseille, France
| | - Salah Boussen
- Assistance Publique Hopitaux de Marseille, CHU Timone, Marseille, France
| | - Thierry Serre
- Université Gustave Eiffel - Campus Méditerranée, Salon de Provence, France
| | - Frédérik Bélot
- Hôpital d'Instruction des Armées Bégin, Saint-Mandé, Île-de-France, France
| |
Collapse
|
2
|
Dunn JC, Elster EA, Blair JA, Remick KN, Potter BK, Nesti LJ. There Is No Role for Damage Control Orthopedics Within the Golden Hour. Mil Med 2021; 187:e17-e21. [PMID: 33484247 DOI: 10.1093/milmed/usaa379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Trauma systems within the United States have adapted the "golden hour" principle to guide prehospital planning with the goal to deliver the injured to the trauma facility in under 60 minutes. In an effort to reduce preventable prehospital death, in 2009, Secretary of Defense Robert M. Gates mandated that prehospital transport of injured combat casualties must be less than 60 minutes. The U.S. Military has implemented a 60-minute timeline for the transport of battlefield causalities to medical teams to include Forward Surgical Teams and Forward Resuscitative Surgical Teams. The inclusion of orthopedic surgeons on Forward Surgical Teams has been extrapolated from the concept of damage control orthopedics (DCO). However, it is not clear if orthopedic surgeons have yielded a demonstrable benefit in morbidity or mortality reduction. The purpose of this article is to investigate the function of orthopedic surgeons during the military "golden hour." MATERIALS AND METHODS The English literature was reviewed for evidence supporting the use of orthopedic surgeons within the golden hour. Literature was reviewed in light of the 2009 golden hour mandate by Secretary Gates as well as those papers which highlighted the utility of DCO within the golden hour. RESULTS Evidence for orthopedic surgery within the "golden hour" or in the current conflicts when the United States enjoys air superiority was not identified. CONCLUSIONS Within the military context, DCO, specifically pertaining to fracture fixation, should not be considered an element of golden hour planning and thus orthopedic surgeons are best utilized at more centralized Role 3 facility locations. The focus within the first hour after injury on the battlefield should be maintained on rapid and effective prehospital care combined with timely evacuation, as these are the most critical factors to reducing mortality.
Collapse
Affiliation(s)
- John C Dunn
- Clinical and Experimental Orthopaedics, Uniformed Services University, Bethesda, MD 79922, USA.,William Beaumont Army Medical Center, Fort Bliss, TX 79922, USA
| | - Eric A Elster
- Clinical and Experimental Orthopaedics, Uniformed Services University, Bethesda, MD, USA.,Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - James A Blair
- William Beaumont Army Medical Center, Fort Bliss, TX 79922, USA
| | - Kyle N Remick
- Clinical and Experimental Orthopaedics, Uniformed Services University, Bethesda, MD, USA.,Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Benjamin K Potter
- Clinical and Experimental Orthopaedics, Uniformed Services University, Bethesda, MD, USA.,Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Leon J Nesti
- Clinical and Experimental Orthopaedics, Uniformed Services University, Bethesda, MD 79922, USA.,Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| |
Collapse
|
3
|
Hu W, Freudenberg V, Gong H, Huang B. The "Golden Hour" and field triage pattern for road trauma patients. JOURNAL OF SAFETY RESEARCH 2020; 75:57-66. [PMID: 33334493 DOI: 10.1016/j.jsr.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/08/2020] [Accepted: 08/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Although the term "golden hour" is a well-known concept among trauma system and emergency medical service providers, the relationship between time and trauma patient outcome and the process of prehospital care for road trauma patients in rural settings are poorly understood. As the underlying basis for triage decision-making, the estimated transport interval to trauma center is usually absent in the existing studies. METHOD In this study, the crash data between 2013 and 2017 were obtained from the Fatality Analysis Reporting System, and the estimated intervals were calculated by using a Geographic Information System software. By comparing the estimated intervals with actual emergency medical services records, the field triage patterns for road patients were investigated at the state and county levels. RESULTS AND CONCLUSIONS With the help of the interval prediction maps, the different triage patterns among counties were identified. Further, the average fatalities per 100,000 population by county from the National Highway Traffic Safety Administration were adopted to clarify the associated outcomes. The linear regression analysis results revealed that, for most states, all intervals except the notification interval had a significant correlation with the mortality. The estimated interval had a more significant relationship with the mortality than the actual transport interval. Practical applications: These findings indicated that adhering to the "golden hour" without regarding the destination may not be helpful for the survival of road trauma patients. The regression analyses and the interval maps can be used to identify patterns of inappropriate destination selection so that prospective decision-making can be improved.
Collapse
Affiliation(s)
- Wei Hu
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN 37996, United States.
| | - Violet Freudenberg
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN 37996, United States
| | - Hongren Gong
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN 37996, United States.
| | - Baoshan Huang
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN 37996, United States.
| |
Collapse
|
4
|
Shibahashi K, Ishida T, Sugiyama K, Kuwahara Y, Okura Y, Hamabe Y. Prehospital times and outcomes of patients who had hypotension at the scene after trauma: A nationwide multicentre retrospective study. Injury 2020; 51:1224-1230. [PMID: 32057459 DOI: 10.1016/j.injury.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/09/2020] [Accepted: 02/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND We aimed to investigate the association between prehospital times and outcomes of patients who had hypotension at the scene after trauma incidents. METHODS We retrospectively analysed records from a nationwide database (2004-2017) of adults (aged ≥15 years) who were hypotensive (systolic blood pressure <90 mmHg) at the scene after trauma. The endpoint was in-hospital mortality. We used multivariable logistic regression analysis to adjust for confounding factors and to estimate the odds ratio (OR) of prehospital times for in-hospital mortality. Stratified analyses were performed based on patient age and type and severity of the trauma. RESULTS Among 5,499 patients included, 906 (16.5%) died in the hospital. The median Injury Severity Score (ISS) was 17 (interquartile range, 9-29). There was a significant trend towards patients having higher in-hospital mortality and ISS when their prehospital times were shorter (P < 0.001). However, the association between prehospital times and in-hospital mortality was not significant after adjusting for confounding factors, with an adjusted odds ratio of 1.00 (95% confidence interval: 0.98-1.01) per 10 min increments in prehospital time. The association remained insignificant when patients were stratified according to age and type and severity of the trauma. CONCLUSIONS Our analysis revealed that prehospital time was not significantly associated with in-hospital mortality among patients who had hypotension at the scene after trauma in the current emergency medical service system in Japan. Further studies are needed to validate our findings.
Collapse
Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
| | - Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yusuke Kuwahara
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yoshihiro Okura
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| |
Collapse
|
5
|
Okada K, Matsumoto H, Saito N, Yagi T, Lee M. Revision of 'golden hour' for hemodynamically unstable trauma patients: an analysis of nationwide hospital-based registry in Japan. Trauma Surg Acute Care Open 2020; 5:e000405. [PMID: 32201736 PMCID: PMC7066640 DOI: 10.1136/tsaco-2019-000405] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background The ‘golden hour’ is a well-known concept, suggesting that shortening time from injury to definitive care is critically important for better outcome of trauma patients. However, there was no established evidence to support it. We aimed to validate the association between time to definitive care and mortality in hemodynamically unstable patients for the current trauma care settings. Methods The data were collected from the Japan Trauma Data Bank between 2006 and 2015. The inclusion criteria were patients with systolic blood pressure (SBP) <90 mm Hg and heart rate (HR) >110 beats/min or SBP <70 mm Hg who underwent definitive care within 4 hours from the onset of injury and survived for more than 4 hours. The outcome measure was in-hospital mortality. We evaluated the relationship between time to definitive care and mortality using the generalized additive model (GAM). Subgroup analysis was also conducted using GAM after dividing the patients into the severe (SBP <70 mm Hg) and moderate (SBP ≥70 mm Hg and <90 mm Hg, and HR >110 beats/min) shock group. Results 1169 patients were enrolled in this study. Of these, 386 (33.0%) died. Median time from injury to definitive care was 137 min. Only 61 patients (5.2%) received definitive care within 60 min. The GAM models demonstrated that mortality remained stable for the early phase, followed by a decrease over time. The severe shock group presented with a paradoxical decline of mortality with time, whereas the moderate shock group had a time-dependent increase in mortality. Discussion We did not observe the association of shorter time to definitive care with a decrease in mortality. However, this was likely an offset result of severe and moderate shock groups. The result indicated that early definitive care could have a positive impact on survival outcome of patients with moderate shock. Level of evidence Level Ⅳ, prognostic study,
Collapse
Affiliation(s)
- Kazuhiro Okada
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hisashi Matsumoto
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuyuki Saito
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Takanori Yagi
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Mihye Lee
- School of Public Health, St Luke's International University, Tokyo, Japan
| |
Collapse
|
6
|
Effects of driving distance and transport time on mortality among Level I and II traumas occurring in a metropolitan area. J Trauma Acute Care Surg 2019; 85:756-765. [PMID: 30086071 DOI: 10.1097/ta.0000000000002041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effects of ambulance driving distance and transport time on mortality among trauma incidents occurring in the City of Chicago, a large metropolitan area. METHODS We studied individuals 16 years or older who suffered a Level I or II injury and were taken to a Level I trauma center. The outcome was in-hospital mortality, including those dead on arrival but excluding those deemed dead on scene. Driving distance was calculated from the scene of injury to the trauma center where the patient was taken. Transport time was defined as the time from scene departure to arrival at the trauma center. Covariates included injury severity measures recorded at the scene. Logistic regression and instrumental variable probit regression models were used to examine the association between driving distance, transport time, and mortality, adjusting for injury severity. RESULTS A total of 24,834 incidents were analyzed, including 1,464 deaths. Median driving distance was 3.9 miles, and median transport time was 13 minutes. Our findings indicate that increased driving distance is associated with a modest increase in mortality, with a covariate-adjusted odds ratio of 1.12 per 2-mile increase in distance (95% confidence interval [CI], 1.05-1.20). This corresponds to an increase in overall mortality of 0.26 percentage points per 2 miles (95% CI, 0.11-0.40). Using distance as an instrumental variable, we estimate a 0.51 percentage point increase in mortality per 5-minute increase in transport time (95% CI, 0.14-0.89). CONCLUSION We find a modest effect of distance on mortality that is approximately linear over a range of 0 to 12 miles. Instrumental variables analysis indicated a corresponding increase in mortality with increasing transport time. Limitations of the study include the possibility of unmeasured confounders and the assumption that distance affects mortality only through its effect on transport time. LEVEL OF EVIDENCE Prognostic study, level III.
Collapse
|
7
|
Becker A, Segal G, Berlin Y, Hershko D. The emergency department length of stay: Is the time running out? Chin J Traumatol 2019; 22:125-128. [PMID: 30956066 PMCID: PMC6543458 DOI: 10.1016/j.cjtee.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To examine the relationships between emergency department length of stay (EDLOS) with hospital length of stay (HLOS) and clinical outcome in hemodynamically stable trauma patients. METHODS Prospective data collected for 2 years from consecutive trauma patients admitted to the trauma resuscitation bay. Only stable blunt trauma patients with appropriate trauma triage criteria requiring trauma team activation were included in the study. EDLOS was determined short if patient spent less than 2 h in the emergency department (ER) and long for more than 2 h. RESULTS A total of 248 patients were enrolled in the study. The mean total EDLOS was 125 min (range 78-180). Injury severity score (ISS) were significantly higher in the long EDLOS group (17 ± 13 versus 11 ± 9, p < 0.001). However, when leveled according to ISS, there were no differences in mean in diagnostic workup, admission rate to intensive care unit (ICU) or HLOS between the short and long EDLOS groups. CONCLUSION EDLOS is not a significant parameter for HLOS in stable trauma patients.
Collapse
|
8
|
Schroeder PH, Napoli NJ, Barnhardt WF, Barnes LE, Young JS. Relative Mortality Analysis Of The “Golden Hour”: A Comprehensive Acuity Stratification Approach To Address Disagreement In Current Literature. PREHOSP EMERG CARE 2018; 23:254-262. [DOI: 10.1080/10903127.2018.1489021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
9
|
Thompson L, Hill M, Davies C, Shaw G, Kiernan MD. Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study. Scand J Trauma Resusc Emerg Med 2017; 25:83. [PMID: 28835283 PMCID: PMC5569481 DOI: 10.1186/s13049-017-0419-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patient outcomes for major trauma within one Regional Trauma Network. METHOD Secondary analysis of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (TARN) was undertaken. The primary outcome used in analysis was 'Status at Discharge' (alive/deceased). Independent variables considered included 'Casualty Characteristics' such as mechanism of injury (MOI), age, and physiological measurements, as well as 'Response Characteristics' such as response timings and skill mix. Binary Logistic Regression analysis using the 'forward stepwise' method was undertaken for physiological measures taken at the scene. RESULTS The study analysed 1033 major trauma records (mean age of 38.5 years, SD 21.5, 95% CI 37-40). Adults comprised 82.6% of the sample (n = 853), whilst 12.9% of the sample were children (n = 133). Men comprised 68.5% of the sample (n = 708) in comparison to 28.8% women (n = 298). Glasgow Coma Score (GCS) (p < 0.000), Respiration Rate (p < 0.001) and Age (p < 0.000), were all significant when associated with the outcome 'Status at Discharge' (alive/deceased). Isolated bivariate associations provided tentative support for response characteristics such as existing dispatching practices and the value of rapid crew arrival. However, these measurements appear to be of limited utility in predictive modelling of outcomes. DISCUSSION The complexity of physiological indices potentially complicate their predictive utility e.g. whilst a Systolic Blood Pressure (SBP) of < 90 mmHg serves as a trigger for bypass to a Major Trauma Centre, the utility of this observation is nullified in cases of Traumatic Brain Injury. Analysis suggested that as people age, outcomes from major trauma significantly worsened. This finding is consistent with existing research highlighting the relationship between trauma in elderly patients and poorer outcomes. CONCLUSION Findings lend further validity to GCS, Respiration Rate and Age as predictive triggers for transport to a Major Trauma Centre. Analysis of interactions between response times, skill mix and triage demand further exploration but tentatively support the 'Golden Hour' concept and suggest a potential 'load and go and play on the way' approach.
Collapse
Affiliation(s)
- Lee Thompson
- North East Ambulance Service NHS Foundation Trust, Trauma Desk, Bernicia House, Goldcrest Way, Newcastle Upon Tyne, NE15 8NY UK
| | - Michael Hill
- Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, NE7 7XA UK
| | - Caroline Davies
- North East Ambulance Service NHS Foundation Trust, Trauma Desk, Bernicia House, Goldcrest Way, Newcastle Upon Tyne, NE15 8NY UK
| | - Gary Shaw
- North East Ambulance Service NHS Foundation Trust, Trauma Desk, Bernicia House, Goldcrest Way, Newcastle Upon Tyne, NE15 8NY UK
| | - Matthew D Kiernan
- Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, NE7 7XA UK
| |
Collapse
|
10
|
Rogers FB, Rittenhouse KJ, Gross BW. The golden hour in trauma: dogma or medical folklore? Injury 2015; 46:525-7. [PMID: 25262329 DOI: 10.1016/j.injury.2014.08.043] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/30/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Frederick B Rogers
- Trauma Services, Lancaster General Hospital, Lancaster, PA, United States.
| | | | - Brian W Gross
- Trauma Services, Lancaster General Hospital, Lancaster, PA, United States.
| |
Collapse
|
11
|
Imen RB, Olfa C, Kamilia C, Meriam B, Hichem K, Adel C, Mabrouk B, Noureddine R. Factors predicting early outcome in patients admitted at emergency department with severe head trauma. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(14)60087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
12
|
Newgard CD, Meier EN, Bulger EM, Buick J, Sheehan K, Lin S, Minei JP, Barnes-Mackey RA, Brasel K. Revisiting the "Golden Hour": An Evaluation of Out-of-Hospital Time in Shock and Traumatic Brain Injury. Ann Emerg Med 2015; 66:30-41, 41.e1-3. [PMID: 25596960 DOI: 10.1016/j.annemergmed.2014.12.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/07/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE We evaluate patients with shock and traumatic brain injury who were previously enrolled in an out-of-hospital clinical trial to test the association between out-of-hospital time and outcome. METHODS This was a secondary analysis of patients with shock and traumatic brain injury who were aged 15 years or older and enrolled in a Resuscitation Outcomes Consortium out-of-hospital clinical trial by 81 emergency medical services agencies transporting to 46 Level I and II trauma centers in 11 sites (May 2006 through May 2009). Inclusion criteria were systolic blood pressure less than or equal to 70 mm Hg or systolic blood pressure 71 to 90 mm Hg with pulse rate greater than or equal to 108 beats/min (shock cohort) and Glasgow Coma Scale score less than or equal to 8 (traumatic brain injury cohort); patients meeting both criteria were placed in the shock cohort. Primary outcomes were 28-day mortality (shock cohort) and 6-month Glasgow Outcome Scale-Extended score less than or equal to 4 (traumatic brain injury cohort). RESULTS There were 778 patients in the shock cohort (26% 28-day mortality) and 1,239 patients in the traumatic brain injury cohort (53% 6-month Glasgow Outcome Scale-Extended score ≤4). Out-of-hospital time greater than 60 minutes was not associated with worse outcomes after accounting for important confounders in the shock cohort (adjusted odds ratio [aOR] 1.42; 95% confidence interval [CI] 0.77 to 2.62) or traumatic brain injury cohort (aOR 0.77; 95% CI 0.51 to 1.15). However, shock patients requiring early critical hospital resources and arriving after 60 minutes had higher 28-day mortality (aOR 2.37; 95% CI 1.05 to 5.37); this finding was not observed among a similar traumatic brain injury subgroup. CONCLUSION Among out-of-hospital trauma patients meeting physiologic criteria for shock and traumatic brain injury, there was no association between time and outcome. However, the subgroup of shock patients requiring early critical resources and arriving after 60 minutes had higher mortality.
Collapse
Affiliation(s)
- Craig D Newgard
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
| | - Eric N Meier
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, WA
| | - Jason Buick
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kellie Sheehan
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Steve Lin
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joseph P Minei
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Roxy A Barnes-Mackey
- Vancouver Fire Department, Vancouver, WA, and the Providence Medical Group, Happy Valley, OR
| | - Karen Brasel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | |
Collapse
|
13
|
Abstract
I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers.
Collapse
|
14
|
Sierink JC, de Jong EW, Schep NW, Goslings JC. Routinely recorded versus dedicated time registrations during trauma work-up. J Trauma Manag Outcomes 2014; 8:11. [PMID: 25225575 PMCID: PMC4164342 DOI: 10.1186/1752-2897-8-11] [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: 10/30/2013] [Accepted: 07/22/2014] [Indexed: 11/18/2022]
Abstract
Introduction Since time intervals are used to determine quality of trauma care, it is relevant to know how reliable those intervals can be measured. The aim of our study was to assess the reliability of time intervals as recorded in our hospital databases. Patients and methods We conducted a prospective study on time intervals in our level-1 trauma centre and compared those with the routinely recorded data from February 2012 to June 2012. A convenience sample of all trauma patients admitted to our trauma room was included. The routinely recorded time intervals were retrieved from computerised hospital databases. The dedicated time registration was done on a standardised form on which five time intervals considered clinically relevant were evaluated for each patient by a dedicated person: trauma room time, time to start CT, imaging time, time from trauma room to ICU and time from trauma room to intervention. Results In a sample of 100 trauma patients dedicated registered trauma room time was median 47 minutes (IQR = 32-63), compared to 42 minutes (IQR = 28-56) in routinely recorded in hospital databases (P < 0.001). Time to start of CT scanning differed significantly as well, with again an increased time interval measured dedicatedly (median 20 minutes (IQR = 15-28)) compared to the routinely recorded time registration (median 13 minutes (IQR = 4-21)). The other time intervals recorded did not differ between the dedicated and routinely recorded registration. Bland-Altman plots also showed that there is considerable discrepancy between the two measurement methods with wide limits of agreement. Conclusion This study shows that routinely recorded time intervals in the trauma care setting differ statistically significant from dedicatedly registered intervals.
Collapse
Affiliation(s)
- Joanne C Sierink
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, the Netherlands
| | - Evin Wm de Jong
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, the Netherlands
| | - Niels Wl Schep
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, the Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, the Netherlands
| |
Collapse
|
15
|
Gholipour C, Vahdati SS, Notash M, Miri SH, Ghafouri RR. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims. Turk J Emerg Med 2014; 14:71-4. [PMID: 27331173 PMCID: PMC4909864 DOI: 10.5505/1304.7361.2014.50103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/27/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a study on the success rate of PHEMS personnel in implementing PHTLS guidelines at the scene of trauma. METHODS Severe trauma patients who had been transferred to the emergency department were included in the study. Evaluations included transfer time, airway management, spinal immobilization, external bleeding management, intravenous (IV) line access, and fluid therapy. All evaluations were performed by an expert emergency physician in the emergency department. RESULTS The mean response time was 17.87±9.1 minutes. The PHEMS personnel immobilized cervical spine in 60.4% of patients, out of whom 16.7% were not properly immobilized. Out of 99 (98%) cases of established IV line access by the PHEMS providers, 57% were satisfactory. Fluid therapy, which was carried out in 99 (98%) patients by the PHEMS personnel, was appropriate in 92% of the cases. CONCLUSIONS PHEMS personnel need more education and supervising to provide services according to PHTLS guidelines.
Collapse
Affiliation(s)
- Changiz Gholipour
- Department of General Surgery, Sina Hospital, Tabriz University of Medical Sciences Tabriz, Iran
| | - Samad Shams Vahdati
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Notash
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Hassan Miri
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | |
Collapse
|
16
|
Adib-Hajbaghery M, Maghaminejad F. Epidemiology of patients with multiple trauma and the quality of their prehospital respiration management in kashan, iran: six months assessment. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e17150. [PMID: 25147774 PMCID: PMC4139695 DOI: 10.5812/atr.17150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 06/21/2014] [Accepted: 06/22/2014] [Indexed: 11/16/2022]
Abstract
Background: Respiration management is an important and critical issue in prehospital transportation phase of multiple trauma patients. However, the quality of this important care has not been assessed in Iran Emergency Medical Services’ (EMS). Objectives: This study was conducted to investigate the quality of prehospital respiration management in patients with multiple trauma, referred to the Shahid Beheshti Trauma Center, Kashan, Iran. Patients and Methods: This cross-sectional study was conducted in the first six months of 2013. All the 400 patients with multiple trauma, transferred by EMS to the Shahid Beheshti Medical Center, were recruited. The study instrument was a checklist, which was completed through observation. Descriptive statistics were presented. Results: Out of all included individuals, 301 were males (75.2%) and 99 were females (24.8%). The most common mechanism of trauma was traffic accident (87.25%). Furthermore, 71.7% of the patients were injured in head and neck and chest areas. The quality of consciousness monitoring and airway management was desirable in 95% of the cases. However, the quality of monitoring patients’ respiration was only desirable in 42% of the cases. Only 18.6% of the patients received oxygen therapy during prehospital transportation. Conclusions: The quality of monitoring patients’ respiration and oxygen therapy was undesirable in most patients with multiple trauma. Therefore, the EMS workers should be retrained to apply proper respiration management in patients with multiple trauma.
Collapse
Affiliation(s)
- Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Farzaneh Maghaminejad
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| |
Collapse
|
17
|
Adib-Hajbaghery M, Maghaminejad F, Paravar M. The quality of pre-hospital oxygen therapy in patients with multiple trauma: a cross-sectional study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14274. [PMID: 24829770 PMCID: PMC4005432 DOI: 10.5812/ircmj.14274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/24/2013] [Accepted: 01/11/2014] [Indexed: 11/16/2022]
Abstract
Background: Trauma is a major healthcare challenge worldwide. In developing countries, most road deaths happen during the pre-hospital phase; consequently, pre-hospital trauma care has received considerable attention during the past decades. Objectives: The aim of this study was to investigate the quality of pre-hospital oxygen therapy in patients with multiple trauma. Patients and Methods: This cross-sectional study was conducted in the year 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services to the central trauma department in Shahid Beheshti Medical Center, Kashan, Iran. The data collection instrument had three parts including demographic, a trauma assessment, and an oxygen therapy quality assessment questionnaires that were designed by the researchers. In total, 350 patients with multiple trauma were recruited from March through July 2013. Data were described by using frequency tables, central tendency measures, and variability indices. Moreover, we analyzed data by using the Chi-square test, Mann-Whitney U test, and the logistic regression analysis. Results: The study sample consisted of 263 (75.1%) male and 87 (24.9%) female patients. Overall, 211 patients needed oxygen therapy during the pre-hospital phase; however, only 35 (16.60%) patients had received oxygen. The quality of oxygen therapy was undesirable in 92.42% of cases. In addition, 83.4% of patients, whose pre-hospital records indicated the administration of oxygen, reported that they had not received oxygen therapy. Logistic regression analysis revealed that the place of accident and the level of patients' education were significant predictors for administration of oxygen during the pre-hospital phase (P < 0.001). Conclusions: The quality of pre-hospital oxygen therapy had been provided for the patients with multiple trauma was poor while these patients, particularly patients with chest traumas and head injuries, were in urgent need of oxygen therapy. Consequently, developing and implementing standard evidence-based oxygen therapy protocols and administrating continuous education programs are recommended.
Collapse
Affiliation(s)
- Mohsen Adib-Hajbaghery
- Trauma Nursing Research Centre, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Farzaneh Maghaminejad
- Trauma Nursing Research Centre , Medical Surgical Nursing Department, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Paravar
- Trauma Nursing Research Centre, Kashan University of Medical Sciences, Kashan, IR Iran
| |
Collapse
|
18
|
Fuller G, Woodford M, Lawrence T, Coats T, Lecky F. Do prolonged primary transport times for traumatic brain injury patients result in deteriorating physiology? A cohort study. PREHOSP EMERG CARE 2013; 18:60-7. [PMID: 24112033 DOI: 10.3109/10903127.2013.831507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent interest has focused on reorganizing emergency medical services (EMS) for traumatic brain injury (TBI) patients, with bypass of nonspecialist hospitals and direct transportation to distant neuroscience centers. Although this could expedite neurosurgery and neurocritical care, deteriorating physiology could be deleterious. METHODS We performed a multicenter cohort study examining adult patients with significant TBI enrolled in the English National Trauma Registry. The distributions and correlation of first recorded prehospital and emergency department (ED) vital signs were compared, and the effect of time on changes in vital signs was examined in bivariate and multivariate analyses. RESULTS A total of 7149 eligible patients were studied. No clinically significant differences were apparent between distributions of prehospital and ED vital signs. Moderate linear correlation was observed for field and ED pulse rate (r(2) = 0.34) and GCS values (Spearman's rho = 0.76), with weak correlation apparent for systolic blood pressure (r(2) = 0.28) and respiratory rate (r(2) = 0.28). Eight percent of cases' vital signs deteriorated in the prehospital interval; however, odds of deterioration in vital sign status did not vary significantly with duration of EMS interval. CONCLUSION The similarity between prehospital and ED vital signs, and lack of association between EMS interval and physiological deterioration, may support a strategy of direct transportation of TBI cases to specialist centers. Further research is necessary to identify patients at risk from deterioration during bypass and to investigate effects on mortality.
Collapse
Affiliation(s)
- Gordon Fuller
- From the Trauma Audit and Research Network, Health Sciences Research Group, Manchester Academic Health Sciences Centre Salford , UK (GF, MW, TL); Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Accident and Emergency Department, Leicester Royal Infirmary , Leicester , UK (TC); and School of Health and Related Research, University of Sheffield , Sheffield , UK (FL)
| | | | | | | | | |
Collapse
|
19
|
Hoogervorst EM, van Beeck EF, Goslings JC, Bezemer PD, Bierens JJLM. Developing process guidelines for trauma care in the Netherlands for severely injured patients: results from a Delphi study. BMC Health Serv Res 2013; 13:79. [PMID: 23452394 PMCID: PMC3621215 DOI: 10.1186/1472-6963-13-79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 02/14/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In organised trauma systems the process of care is the key to quality. Nevertheless, the optimal process of trauma care remains unclear due to lack of or inconclusive evidence. Because monitoring and improving the performance of a trauma system is complex, this study aimed to develop consensus-based process guidelines for trauma care in the Netherlands for severely injured patients. METHODS A five-round Delphi study was conducted with 141 participants that represent all professions involved in trauma care. Sensitivity analyses were carried out to evaluate whether consensus extended across all professions and to detect possible bias. RESULTS Consensus was reached on 21 guidelines within 4 categories: timeliness, actions, competent teams and interdisciplinary process. Timeliness guidelines set specific critical limits and definitions for 10 time intervals in the time period from an emergency call until the patient leaves the trauma room. Action guidelines reflect aspects of appropriate care and strongly rely on the international Advanced Trauma Life Support principles. Competence guidelines include flow charts to assess the competence of prehospital and emergency department teams. Essential to competent teams are education and experience of all team members. The interdisciplinary process guideline focuses on cooperation, communication and feedback within and between all professions involved. Consensus was extended across all professions and no bias was detected. CONCLUSIONS In this Delphi study, a large expert panel agreed on a set of guidelines describing the optimal process of care for severely injured trauma patients in the Netherlands. In addition to time intervals and appropriate actions, these guidelines emphasise the importance of team competence and interdisciplinary processes in trauma care. The guidelines can be seen as a description of a best practice and a new field standard in the Netherlands. The next step is to implement the guidelines and monitor the performance of the Dutch trauma system based on the guidelines.
Collapse
|
20
|
McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. Emergency Medical Services Out-of-Hospital Scene and Transport Times and Their Association With Mortality in Trauma Patients Presenting to an Urban Level I Trauma Center. Ann Emerg Med 2013; 61:167-74. [DOI: 10.1016/j.annemergmed.2012.08.026] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 05/26/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
|
21
|
McHugh M. The Consequences of Emergency Department Crowding and Delays for Patients. INTERNATIONAL SERIES IN OPERATIONS RESEARCH & MANAGEMENT SCIENCE 2013. [DOI: 10.1007/978-1-4614-9512-3_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
22
|
Disaster metrics: quantitative estimation of the number of ambulances required in trauma-related multiple casualty events. Prehosp Disaster Med 2012; 27:445-51. [PMID: 22985618 DOI: 10.1017/s1049023x12001094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Estimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task. HYPOTHESIS/PROBLEM Emergency medical services (EMS) regions in the United States have varying "best practices" for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients. The proposed model takes into consideration the different transport times and capacities of receiving hospitals, the time interval from injury occurrence, the number of patients per ambulance, and the pre-designated time frame allowed from injury until the transfer care of T1 and T2 patients. METHODS The main theoretical framework for this model was based on prehospital time intervals described in the literature and used by EMS systems to evaluate operational and patient care issues. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for simplicity. RESULTS The minimum number of ambulances required to respond to the scene of an MCE was modeled as being primarily dependent on the number of critical patients (T1) present at the scene any particular time. A robust quantitative model was also proposed to dynamically estimate the number of ambulances needed at any time during an MCE to treat, transport and transfer the care of T1 and T2 patients. CONCLUSION A new quantitative model for estimation of the number of ambulances needed during the prehospital response in trauma-related multiple casualty events has been proposed. Prospective studies of this model are needed to examine its validity and applicability.
Collapse
|
23
|
Debacker M, Hubloue I, Dhondt E, Rockenschaub G, Rüter A, Codreanu T, Koenig KL, Schultz C, Peleg K, Halpern P, Stratton S, Della Corte F, Delooz H, Ingrassia PL, Colombo D, Castrèn M. Utstein-style template for uniform data reporting of acute medical response in disasters. PLOS CURRENTS 2012; 4:e4f6cf3e8df15a. [PMID: 23066513 PMCID: PMC3461975 DOI: 10.1371/4f6cf3e8df15a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims. METHODS Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique. RESULTS The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement. CONCLUSION It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.
Collapse
Affiliation(s)
- Michel Debacker
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Belgium. Academy for Emergency Management and Disaster Medicine (EMDM Academy)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Serviá L, Badia M, Baeza I, Montserrat N, Justes M, Cabré X, Valdrés P, Trujillano J. Time spent in the emergency department and mortality rates in severely injured patients admitted to the intensive care unit: An observational study. J Crit Care 2012; 27:58-65. [DOI: 10.1016/j.jcrc.2011.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 06/08/2011] [Accepted: 07/07/2011] [Indexed: 02/03/2023]
|
26
|
Zong ZW, Li N, Cheng TM, Ran XZ, Shen Y, Zhao YF, Guo QS, Zhang LY. Current state and future perspectives of trauma care system in mainland China. Injury 2011; 42:874-8. [PMID: 21081228 DOI: 10.1016/j.injury.2010.09.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/09/2010] [Accepted: 09/27/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the current state of trauma care in mainland China, and to propose possible future suggestions for the development of the trauma care system in mainland China. METHOD An extensive Medline/PubMed search on the topic of trauma care or trauma care system was conducted. Publications in Chinese that could best describe the state of trauma care in China were also included. In addition, two meetings were held by Group for Trauma Emergency Care and Multiple Injuries, Trauma Society of Chinese Medical Association to discuss the development and perspectives of trauma care system in mainland China. Important conclusions from the two meetings were included in this publication. RESULTS Trauma has become an increasing public health problem in mainland China in association with the rapid growth of the economy over the past 30 years. Although great progress has been made in regards to the care of the injured, there is still no government agency dedicated to deal with trauma-related issues, or a national trauma care system operating on the Chinese mainland. Various trauma prevention measures have been taken, but with little effect. Funds contributed to trauma-related research has increased in recent years and promoted rapid development in this field, but further improvement in research is needed. However, many groups such as the Trauma Society of the Chinese Medical Association have continued to explore mechanisms for the treatment of trauma patients and have developed various types of regional trauma care systems, resulting in improved trauma care and a better outcome for the injured. CONCLUSIONS Although great progress has been made in trauma care in mainland China, there are many failings. To improve trauma care in China, the establishment of a sophisticated trauma system and various enhancements on trauma prevention are urgently required.
Collapse
Affiliation(s)
- Zhao-wen Zong
- Department of Trauma Surgery, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Third Military Medical University, ChongQing 400042, PR China.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
OBJECTIVE Multiple quality indicators are available to evaluate adult trauma care, but their characteristics and outcomes have not been systematically compared. We sought to systematically review the evidence about the reliability, validity, and implementation of quality indicators for evaluating trauma care. DATA SOURCES Search of MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 14, 2009; the Gray Literature; select journals by hand; reference lists; and articles recommended by experts in the field. STUDY SELECTION Studies were selected that evaluated the reliability, validity, or the impact of one or more quality indicators on the quality of care delivered to patients ≥ 18 yrs of age with a major traumatic injury. DATA EXTRACTION Reviewers with methodologic and content expertise conducted data extraction independently. DATA SYNTHESIS The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment; 40 articles were selected for review. Of these, 20 (50%) articles were cohort studies and 13 (33%) articles were case series. Five articles used control groups, including three before and after case series, a case-control study, and a nonrandomized controlled trial. A total of 115 quality indicators in adult trauma care was identified, predominantly measures of hospital processes (62%) and outcomes (17%) of care. We did not identify any posthospital or secondary injury prevention quality indicators. Reliability was described for two quality indicators, content validity for 22 quality indicators, construct validity for eight quality indicators, and criterion validity for 46 quality indicators. A total of 58 quality indicators was implemented and evaluated in three studies. Eight quality indicators had supporting evidence for more than one measurement domain. A single quality indicator, peer review for preventable death, had both reliability and validity evidence. CONCLUSIONS Although many quality indicators are available to measure the quality of trauma care, reliability evidence, validity evidence, and description of outcomes after implementation are limited.
Collapse
|
28
|
Breil B, Fritz F, Thiemann V, Dugas M. Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains. BMC Med Inform Decis Mak 2011; 11:34. [PMID: 21609424 PMCID: PMC3125312 DOI: 10.1186/1472-6947-11-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format. METHODS Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions. RESULTS More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed. CONCLUSION Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.
Collapse
Affiliation(s)
- Bernhard Breil
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany.
| | | | | | | |
Collapse
|
29
|
Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, Aufderheide TP, Minei JP, Hata JS, Gubler KD, Brown TB, Yelle JD, Bardarson B, Nichol G. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med 2009; 55:235-246.e4. [PMID: 19783323 DOI: 10.1016/j.annemergmed.2009.07.024] [Citation(s) in RCA: 213] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 06/19/2009] [Accepted: 07/22/2009] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE The first hour after the onset of out-of-hospital traumatic injury is referred to as the "golden hour," yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality. METHODS This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged > or =15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007. Inclusion criteria were systolic blood pressure less than or equal to 90 mm Hg, respiratory rate less than 10 or greater than 29 breaths/min, Glasgow Coma Scale score less than or equal to 12, or advanced airway intervention. The outcome was in-hospital mortality. We evaluated EMS intervals (activation, response, on-scene, transport, and total time) with logistic regression and 2-step instrumental variable models, adjusted for field-based confounders. RESULTS There were 3,656 trauma patients available for analysis, of whom 806 (22.0%) died. In multivariable analyses, there was no significant association between time and mortality for any EMS interval: activation (odds ratio [OR] 1.00; 95% confidence interval [CI] 0.95 to 1.05), response (OR 1.00; 95% CI 9.97 to 1.04), on-scene (OR 1.00; 95% CI 0.99 to 1.01), transport (OR 1.00; 95% CI 0.98 to 1.01), or total EMS time (OR 1.00; 95% CI 0.99 to 1.01). Subgroup and instrumental variable analyses did not qualitatively change these findings. CONCLUSION In this North American sample, there was no association between EMS intervals and mortality among injured patients with physiologic abnormality in the field.
Collapse
Affiliation(s)
- Craig D Newgard
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Di Bartolomeo S, Valent F, Sanson G, Nardi G, Gambale G, Barbone F. Are the ACSCOT filters associated with outcome? Examining morbidity and mortality in a European setting. Injury 2008; 39:1001-6. [PMID: 18657809 DOI: 10.1016/j.injury.2008.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 03/07/2008] [Accepted: 04/14/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Quality indicators are widely needed for external assessment and comparison of trauma care. It is common to extend the use of the American College of Surgeons Committee on Trauma (ACSCOT) audit filters to this scope. This mandates that their actual link with outcome be demonstrated. Several studies attempted to do so, but with inconsistent risk-adjustment, conflicting results and never using long-term disability as outcome measure, despite its recognised importance. We tried to overcome these limitations. METHODS Risk-adjusted analysis of the association of filters 1, 3, 10 and 13 with 30-day mortality and 6-month disability measured with the EQ5D scale. Multivariate logistic and linear regression models were used respectively. The data came from a National Italian Trauma Registry comprising 838 patients with major trauma. RESULTS Three (1, 3 and 10) of the filters analysed did not show any significant association with either outcome. Filter 13 was associated with decreased mortality and lower (worse) disability scores. CONCLUSIONS Methodological difficulties, incomplete, obsolete or non-generalizable definitions of some filters can explain the generally poor correlation with outcomes. The conflicting association of filter 13 with the two types of outcomes raises some interesting questions about the targeted outcomes in trauma research. It is recommended that further studies develop better quality indicators and test their link with both survival and functional outcome in the same setting where they are applied for assessment and comparison of trauma care.
Collapse
|