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Wolthers SA, Jensen TW, Breindahl N, Milling L, Blomberg SN, Andersen LB, Mikkelsen S, Torp-Pedersen C, Christensen HC. Traumatic cardiac arrest - a nationwide Danish study. BMC Emerg Med 2023; 23:69. [PMID: 37340347 PMCID: PMC10283219 DOI: 10.1186/s12873-023-00839-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Cardiac arrest following trauma is a leading cause of death, mandating urgent treatment. This study aimed to investigate and compare the incidence, prognostic factors, and survival between patients suffering from traumatic cardiac arrest (TCA) and non-traumatic cardiac arrest (non-TCA). METHODS This cohort study included all patients suffering from out-of-hospital cardiac arrest in Denmark between 2016 and 2021. TCAs were identified in the prehospital medical record and linked to the out-of-hospital cardiac arrest registry. Descriptive and multivariable analyses were performed with 30-day survival as the primary outcome. RESULTS A total of 30,215 patients with out-of-hospital cardiac arrests were included. Among those, 984 (3.3%) were TCA. TCA patients were younger and predominantly male (77.5% vs 63.6%, p = < 0.01) compared to non-TCA patients. Return of spontaneous circulation occurred in 27.3% of cases vs 32.3% in non-TCA patients, p < 0.01, and 30-day survival was 7.3% vs 14.2%, p < 0.01. An initial shockable rhythm was associated with increased survival (aOR = 11.45, 95% CI [6.24 - 21.24] in TCA patients. When comparing TCA with non-TCA other trauma and penetrating trauma were associated with lower survival (aOR: 0.2, 95% CI [0.02-0.54] and aOR: 0.1, 95% CI [0.03 - 0.31], respectively. Non-TCA was associated with an aOR: 3.47, 95% CI [2.53 - 4,91]. CONCLUSION Survival from TCA is lower than in non-TCA. TCA has different predictors of outcome compared to non-TCA, illustrating the differences regarding the aetiologies of cardiac arrest. Presenting with an initial shockable cardiac rhythm might be associated with a favourable outcome in TCA.
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Affiliation(s)
- Signe Amalie Wolthers
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Theo Walther Jensen
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
| | - Niklas Breindahl
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise Milling
- Department of Regional Health Research, Prehospital Research Unit, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Stig Nikolaj Blomberg
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
| | - Lars Bredevang Andersen
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
| | - Søren Mikkelsen
- Department of Regional Health Research, Prehospital Research Unit, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), National Clinical Registries, Copenhagen, Denmark
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Beaumont-Boileau R, Nadeau A, Tardif PA, Malo C, Emond M, Moore L, Clément J, Mercier E. Performance of a provincial prehospital trauma triage protocol: A retrospective audit. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231156263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Objective To assess the accuracy of a five-step prehospital trauma triage protocol ( Échelle québécoise de triage préhospitalier en traumatologie (EQTPT)) to identify patients requiring urgent and specialized in-hospital trauma care in the Capitale-Nationale region – Québec. Methods The medical records of trauma patients transported by ambulance to one of the five participating emergency departments (EDs) between November 2016 and March 2017 were reviewed. Our primary outcome was the need for one of the following urgent and specialized trauma care: endotracheal intubation in the ED, administration of ≥ 2 blood products in the ED, angioembolization or surgery (excluding single limb surgery) < 24 h and admission to the intensive care unit (ICU) or in-hospital trauma-related death. Results A total of 902 patients were included. The median age was 63 (interquartile range (IQR) 51) and 494 (54.8%) were female. The main trauma mechanism was falls (n = 592), followed by motor vehicle accidents (n = 201). Eighty-two (9.1%) patients required at least one urgent and specialized trauma care. Of those, 44 (53.6%) were identified as requiring transport to a level one trauma centre (steps 1–3), 16 were identified as requiring transport to a centre with a lower level of trauma designation (steps 4–5) while 22 (26.8%) did not meet any of the EQTPT criteria. For steps 1 to 3, the sensitivity was 53.7% (95% confidence interval (CI) 42.9–64.4) and the specificity was 81.7% (95% CI 79.1–84.4) in identifying patients requiring specialized trauma care. Conclusion The EQTPT lacked sensitivity and was poorly specific to identify trauma patients who need specialized in-hospital trauma care.
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Affiliation(s)
- Roxane Beaumont-Boileau
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Alexandra Nadeau
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Pier-Alexandre Tardif
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Christian Malo
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Marcel Emond
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Lynne Moore
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Julien Clément
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
- Département de Chirurgie, CHU de Québec, Québec, Canada
| | - Eric Mercier
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
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Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients. Eur J Trauma Emerg Surg 2022; 49:1425-1431. [DOI: 10.1007/s00068-022-02194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
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Mitra B, Fogarty M, Cameron PA, Smith K, Bernard S, Burke M, Mercier E, Beck B. Cardiovascular and liver disease among pre-hospital trauma deaths: A review of autopsy findings. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408620954087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Pre-existing disease is a common contributor to mortality and morbidity after injury and resuscitation of injured patients are often altered in hospital based on comorbidities. However, this is uncommon in the pre-hospital phase of care where patients are managed according to clinical practice guidelines. This study aimed to quantify the prevalence of cardiovascular disease (CVD) and liver disease among trauma patients attended by pre-hospital clinicians but who died prior to reaching hospital and assess associations with age. Methods This was a retrospective review of pre-hospital trauma deaths in the state of Victoria, Australia between 01 Jan 2008 and 31 Dec 2014. The inclusion criteria were (a) patients attended by pre-hospital clinicians, (b) deceased before arrival to hospital, (c) evidence of recent trauma and (d) underwent a full autopsy. Cardiovascular and liver disease status were extracted from autopsy reports. Results There were 1043 patients included in this study. Most patients were male (77.1%). Intentional self-harm was significantly more common in patients aged ≥65 years (17.4%). CVD was prevalent in 495 (47.5%; 95%CI: 44.4–50.5) cases with myocardial fibrosis the most common abnormality detected. All sub-groups of CVD demonstrated a significant association with increasing age, except right ventricular hypertrophy. Liver disease was present in 235 (22.5%; 95%CI: 20.1-25.2) patients and most common among patients aged 35–64 years. Discussion CVD was prevalent in almost half of all injured patients included in this study while liver disease was present in about a fifth. The prevalence of CVD was associated with increasing age, while liver disease was more common among middle-aged patients. This high prevalence in our population indicates that pre-existing cardiovascular and liver disease be considered when tailoring pre-hospital life-saving interventions for injured patients.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fogarty
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Steve Bernard
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Michael Burke
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Eric Mercier
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Axis, Université Laval, Quebec City, Québec, Canada
- Département de Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Université Laval, Quebec City, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de Université Laval, Quebec City, Québec, Canada
| | - Ben Beck
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Carmichael H, Samuels JM, Jamison EC, Bol KA, Coleman JJ, Campion EM, Velopulos CG. Finding the elusive trauma denominator: Feasibility of combining data sets to quantify the true burden of firearm trauma. J Trauma Acute Care Surg 2021; 90:466-470. [PMID: 33105286 DOI: 10.1097/ta.0000000000003005] [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: 11/27/2022]
Abstract
BACKGROUND Evidence guiding firearm injury prevention is limited by current data collection infrastructure. Trauma registries (TR) omit prehospital deaths and underestimate the burden of injury. In contrast, the National Violent Death Reporting System (NVDRS) tracks all firearm deaths including prehospital fatalities, excluding survivors. This is a feasibility study to link these data sets through collaboration with our state public health department, aiming to better estimate the burden of firearm injury and assess comparability of data. METHODS We reviewed all firearm injuries in our Level I TR from 2011 to 2017. We provided the public health department with in-hospital deaths, which they linked to NVDRS using patient identifiers and time of injury/death. The NVDRS collates information about circumstances, incident type, and wounding patterns from multiple sources including death certificates, autopsy records, and legal proceedings. We considered only subjects with injury location in a single urban county to best estimate in-hospital and prehospital mortality. RESULTS Of 168 TR deaths, 166 (99%) matched to NVDRS records. Based on data linkages, we estimate 320 prehospital deaths, 184 in-hospital deaths, and 453 survivors for a total of 957 firearm injuries. For the matched patients, there was near-complete agreement regarding simple demographic variables (e.g., age and sex) and good concordance between incident types (suicide, homicide, etc.). However, agreement in wounding patterns between NVDRS and TR varied. CONCLUSION We demonstrate the feasibility of linking TR and NVDRS data with good concordance for many variables, allowing for good estimation of the trauma denominator. Standardized data collection methods in one data set could improve methods used by the other, for example, training NVDRS abstractors to utilize Abbreviated Injury Scale designations for injury patterns. Such data integration holds immediate promise for guiding prevention strategies. LEVEL OF EVIDENCE Epidemiological study, level IV.
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Affiliation(s)
- Heather Carmichael
- From the University of Colorado (H.C., J.M.S., C.G.V.), Aurora; Colorado Department of Public Health and Environment (E.C.J., K.A.B.), Health Statistics and Evaluation Branch; and Department of Surgery (J.J.C., E.M.C.), Denver Health Medical Center, Denver, Colorado
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Lewis CY, Carmona RH, Roberts CS. Should every physician be ready to act as a community first responder? Injury 2020; 51:2731-2733. [PMID: 33077162 PMCID: PMC7547631 DOI: 10.1016/j.injury.2020.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Chad Y. Lewis
- Dartmouth College, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Richard H. Carmona
- 17th Surgeon General of the United States, University of Arizona, Tucson, Arizona, USA
| | - Craig S. Roberts
- Department of Orthopaedic Surgery, University of Louisville, School of Medicine, Louisville, Kentucky, USA,Corresponding author
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Alqudah Z, Nehme Z, Williams B, Oteir A, Bernard S, Smith K. Impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest on survival outcomes. Resuscitation 2020; 158:79-87. [PMID: 33253769 DOI: 10.1016/j.resuscitation.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/07/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
AIM We aimed to investigate the impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest (OHCA) on emergency medical service (EMS) attempted resuscitations and survival outcomes. METHODS A retrospective observational study of traumatic OHCA cases involving patients aged > 16 years in Victoria, Australia, who arrested between 2001 and 2018. Unadjusted and adjusted logistic regression was performed to assess trends in survival outcomes over the study period. RESULTS Between 2001 and 2018, the EMS attended 5,631 cases of traumatic OHCA, of which 1,237 cases (22.0%) received an attempted resuscitation. EMS response times increased significantly over time (from 7.0 min in 2001-03 to 9.8 min in 2016-18; p trend < 0.001) as did rates of bystander cardiopulmonary resuscitation (CPR) (from 37.8% to 63.6%; p trend < 0.001). Helicopter EMS attendance on scene increased from 7.1% to 12.4% (p trend = 0.01), and transports of patients with return of spontaneous circulation (ROSC) to designated major trauma centres also increased from 36.6% to 82.4% (p trend < 0.001). The frequency of EMS trauma-specific interventions increased over the study period, including needle thoracostomy from 7.7% to 61.6% (p trend < 0.001). Although the risk-adjusted odds of ROSC (OR 1.06, 95% CI: 1.03-1.10) and event survival (OR 1.05, 95% CI: 1.01-1.09) increased year-on-year, there were no temporal changes in survival to hospital discharge. CONCLUSION Despite higher rates of bystander CPR and EMS trauma interventions, rates of survival following traumatic OHCA did not change over time in our region. More studies are needed to investigate the optimal EMS interventions for improved survival in traumatic OHCA.
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Affiliation(s)
- Zainab Alqudah
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Allied Medical Sciences, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan.
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Alaa Oteir
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Allied Medical Sciences, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
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Kool B, Lilley R, Davie G, de Graaf B, Reid P, Branas C, Civil I, Dicker B, Ameratunga SN. Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study. Inj Prev 2020; 27:injuryprev-2019-043408. [PMID: 32447305 DOI: 10.1136/injuryprev-2019-043408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand. METHODS A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009-2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25-49) and non-survivable (ISS >49). RESULTS Of the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. 'Non-survivable' injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15-29 year. The majority of 'survivable' cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care. DISCUSSION In New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.
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Affiliation(s)
- Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pararangi Reid
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ian Civil
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Dicker
- Paramedicine Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Beck B, Smith K, Mercier E, Bernard S, Jones C, Meadley B, Clair TS, Jennings PA, Nehme Z, Burke M, Bassed R, Fitzgerald M, Judson R, Teague W, Mitra B, Mathew J, Buck A, Varma D, Gabbe B, Bray J, McLellan S, Ford J, Siedenburg J, Cameron P. Potentially preventable trauma deaths: A retrospective review. Injury 2019; 50:1009-1016. [PMID: 30898389 DOI: 10.1016/j.injury.2019.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/24/2019] [Accepted: 03/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reviewing prehospital trauma deaths provides an opportunity to identify system improvements that may reduce trauma mortality. The objective of this study was to identify the number and rate of potentially preventable trauma deaths through expert panel reviews of prehospital and early in-hospital trauma deaths. METHODS We conducted a retrospective review of prehospital and early in-hospital (<24 h) trauma deaths following a traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria (AV) in the state of Victoria, Australia, between 2008 and 2014. Expert panels were used to review cases that had resuscitation attempted by paramedics and underwent a full autopsy. Patients with a mechanism of hanging, drowning or those with anatomical injuries deemed to be unsurvivable were excluded. RESULTS Of the 1183 cases that underwent full autopsies, resuscitation was attempted by paramedics in 336 (28%) cases. Of these, 113 cases (34%) were deemed to have potentially survivable injuries and underwent expert panel review. There were 90 (80%) deaths that were not preventable, 19 (17%) potentially preventable deaths and 4 (3%) preventable deaths. Potentially preventable or preventable deaths represented 20% of those cases that underwent review and 7% of cases that had attempted resuscitation. CONCLUSIONS The number of potentially preventable or preventable trauma deaths in the pre-hospital and early in-hospital resuscitation phase was low. Specific circumstances were identified in which the trauma system could be further improved.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Eric Mercier
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; The Intensive Care Unit, The Alfred Hospital
| | | | - Ben Meadley
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | - Toby St Clair
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | - Paul A Jennings
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | - Michael Burke
- Victorian Institute of Forensic Medicine, Victoria, Australia
| | - Richard Bassed
- Victorian Institute of Forensic Medicine, Victoria, Australia; Department of Forensic Medicine, Monash University, Victoria, Australia
| | - Mark Fitzgerald
- Trauma Service, The Alfred, Victoria, Australia; National Trauma Research Institute, Victoria, Australia
| | - Rodney Judson
- General Surgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Warwick Teague
- Trauma Service, The Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; National Trauma Research Institute, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Joseph Mathew
- Trauma Service, The Alfred, Victoria, Australia; National Trauma Research Institute, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Andrew Buck
- Emergency Department, Royal Darwin Hospital, Northern Territory, Australia
| | - Dinesh Varma
- Department of Surgery, The University of Melbourne, Victoria, Australia; Radiology, The Alfred, Victoria, Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Susan McLellan
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Jane Ford
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Josine Siedenburg
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; National Trauma Research Institute, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
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Abstract
INTRODUCTION Regionalised trauma systems have been shown to improve outcomes for trauma patients. However, the evaluation of these trauma systems has been oriented towards in-hospital care. Therefore, the epidemiology and care delivered to the injured patients who died in the prehospital setting remain poorly studied. This study aims to provide an overview of a methodological approach to reviewing trauma deaths in order to assess the preventability, identify areas for improvements in the system of care provided to these patients and evaluate the potential for novel interventions to improve outcomes for seriously injured trauma patients. METHODS AND ANALYSIS The planned study is a retrospective review of prehospital and early in-hospital (<24 hours) deaths following traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria between 2008 and 2014. Eligible patients will be identified from the Victorian Ambulance Cardiac Arrest Registry and linked with the National Coronial Information System. For patients who were transported to hospital, data will be linked the Victoria State Trauma Registry. The project will be undertaken in four phases: (1) survivability assessment; (2) preventability assessment; (3) identification of potential areas for improvement; and (4) identification of potentially useful novel technologies. Survivability assessment will be based on predetermined anatomical injuries considered unsurvivable. For patients with potentially survivable injuries, multidisciplinary expert panel reviews will be conducted to assess the preventability as well as the identification of potential areas for improvement and the utility of novel technologies. ETHICS AND DISSEMINATION The present study was approved by the Victorian Department of Justice and Regulation HREC (CF/16/272) and the Monash University HREC (CF16/532 - 2016000259). Results of the study will be published in peer-reviewed journals and reports provided to Ambulance Victoria, the Victorian State Trauma Committee and the Victorian State Government Department of Health and Human Services.
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Affiliation(s)
- Eric Mercier
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Center for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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11
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Brown E, Williams TA, Tohira H, Bailey P, Finn J. Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia. Emerg Med Australas 2018; 30:827-833. [PMID: 30044053 DOI: 10.1111/1742-6723.13148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/29/2018] [Accepted: 06/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the study was to describe the epidemiology of trauma in adult patients attended by ambulance paramedics in Perth, Western Australia. METHODS A retrospective cohort study of trauma patients aged ≥16 years attended by St John Ambulance Western Australia (SJA-WA) paramedics in greater metropolitan Perth between 2013 and 2016 using the SJA-WA database and WA death data. Incidence and 30 day mortality rates were calculated. Patients who died prehospital (immediate deaths), on the day of injury (early deaths), within 30 days (late deaths) and those who survived longer than 30 days (survivors) were compared for age, sex, mechanism of injury and acuity level. Prehospital interventions were also reported. RESULTS Overall, 97 724 cases were included. A statistically significant increase in the incidence rate occurred over the study period (from 1466 to 1623 per 100 000 population year P ≤ 0.001). There were 2183 deaths within 30 days (n = 2183/97 724, 2.2%). Motor vehicle accidents were responsible for most immediate and early deaths (n = 98/203, 48.3% and n = 72/156, 46.2%, respectively). The majority of transported patients were low acuity (acuity levels 3 to 5, n = 60 594/79 887, 75.8%) and high-acuity patients accounted for 2.7% (n = 2176/79 997). Analgesia administration was the most frequently performed intervention (n = 32 333/80 643, 40.1%), followed by insertion of intravenous catheters (n = 25 060/80 643, 31.1%). Advanced life support interventions such as endotracheal intubation were performed in <1% of patients. CONCLUSION The trauma incidence rate increased over time and the majority of patients had low-acuity injuries. Focusing research, training and resources solely on high-acuity patients will not cater for the needs of the majority of patients.
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Affiliation(s)
- Elizabeth Brown
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Teresa A Williams
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,St John Ambulance Western Australia, Perth, Western Australia, Australia.,Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,St John Ambulance Western Australia, Perth, Western Australia, Australia.,Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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