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Al-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, Al-Sulaiti M, Abdelrahman H. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. Eur J Trauma Emerg Surg 2018; 45:393-401. [DOI: 10.1007/s00068-018-0948-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
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Lillebo B, Seim A, Vinjevoll OP, Uleberg O. What is optimal timing for trauma team alerts? A retrospective observational study of alert timing effects on the initial management of trauma patients. J Multidiscip Healthc 2012; 5:207-13. [PMID: 22973111 PMCID: PMC3430097 DOI: 10.2147/jmdh.s33740] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Trauma teams improve the initial management of trauma patients. Optimal timing of trauma alerts could improve team preparedness and performance while also limiting adverse ripple effects throughout the hospital. The purpose of this study was to evaluate how timing of trauma team activation and notification affects initial in-hospital management of trauma patients. Methods Data from a single hospital trauma care quality registry were matched with data from a trauma team alert log. The time from patient arrival to chest X-ray, and the emergency department length of stay were compared with the timing of trauma team activations and whether or not trauma team members received a preactivation notification. Results In 2009, the trauma team was activated 352 times; 269 times met the inclusion criteria. There were statistically significant differences in time to chest X-ray for differently timed trauma team activations (P = 0.003). Median time to chest X-ray for teams activated 15–20 minutes prearrival was 5 minutes, and 8 minutes for teams activated <5 minutes before patient arrival. Timing had no effect on length of stay in the emergency department (P = 0.694). We found no effect of preactivation notification on time to chest X-ray (P = 0.474) or length of stay (P = 0.684). Conclusion Proactive trauma team activation improved the initial management of trauma patients. Trauma teams should be activated prior to patient arrival.
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Affiliation(s)
- Borge Lillebo
- Norwegian EHR Research Centre, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Video registration of trauma team performance in the emergency department: the results of a 2-year analysis in a Level 1 trauma center. ACTA ACUST UNITED AC 2010; 67:1412-20. [PMID: 20009695 DOI: 10.1097/ta.0b013e31818d0e43] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. METHODS We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols. RESULTS From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated. CONCLUSIONS Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.
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Santiano N, Baramy LS, Young L, Saggu G, Cabrera R, Parr M. Problems and solutions arising during a study in visual semantics of the medical emergency team system. QUALITATIVE HEALTH RESEARCH 2008; 18:1336-1344. [PMID: 18713942 DOI: 10.1177/1049732308322595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A study of the medical emergency team (MET) to explore communication within the team, leadership, handover, and MET resuscitation practice was performed using audiovisual recording in hospitals of Sydney South West Area Health Service, Sydney, Australia. In this article, we report on the process of data collection: the completion of 25 video recordings of MET calls across three of the six study hospitals. We describe how we gained entry into hospital environments to film events characterized by the unpredictability and uncertainties associated with resuscitating a patient and the strategies that we implemented during the fieldwork to develop and maintain rapport with both clinicians and managers. We describe how we addressed some of the practical constraints related to collecting audiovisual data at the point of acute care as well as their implications for the theoretical and methodological aspects of the study.
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Affiliation(s)
- Nancy Santiano
- Liverpool Health Service, The Simpson Centre, Liverpool, New South Wales, Australia.
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Ollerton JE, Sugrue M, Balogh Z, D'Amours SK, Giles A, Wyllie P. Prospective Study to Evaluate the Influence of FAST on Trauma Patient Management. ACTA ACUST UNITED AC 2006; 60:785-91. [PMID: 16612298 DOI: 10.1097/01.ta.0000214583.21492.e8] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have concentrated on the accuracy of Focused Assessment with Sonography in Trauma (FAST), but evaluation of whether FAST changes subsequent management has not been fully assessed. METHODS This prospective study compared 419 trauma admissions in two groups, FAST and no-FAST, for demographics, time of resuscitation, and action after resuscitation. The 194 patients undergoing FAST had their management plan specified before, and confirmed after, FAST was performed to assess for change in management. To ensure scan consistency and to minimize bias, criteria were established to define an adequate FAST. RESULTS FAST was performed in 194 patients (46%), assessing for free fluid. Management was changed in 59 cases (32.8%) after FAST. Laparotomy was prevented in 1 patient, computed tomography was prevented in 23 patients, and diagnostic peritoneal lavage was prevented in 15 patients. Computed tomography rates were reduced from 47% to 34% and diagnostic peritoneal lavage rates were reduced from 9% to 1%. CONCLUSIONS FAST plays a key role in trauma, changing subsequent management in an appreciable number of patients.
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Affiliation(s)
- J E Ollerton
- Department of Trauma, Liverpool Hospital, New South Wales, Australia.
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Smith J, Caldwell E, Sugrue M. Difference in trauma team activation criteria between hospitals within the same region. Emerg Med Australas 2005; 17:480-7. [PMID: 16302941 DOI: 10.1111/j.1742-6723.2005.00780.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The present study was conducted to establish the current criteria for trauma team activation (TTA) in hospitals in the Metropolitan Sydney area, and examine the rationale behind their use. METHODS A cross-sectional survey was undertaken of the seven hospitals in the Metropolitan Sydney area designated to receive adult major trauma in March 2004. Trauma coordinators in each hospital provided the criteria used for adult TTA within their hospital. RESULTS All seven hospitals replied with their TTA criteria and completed the survey. The results show a wide variation in those criteria used by hospitals to activate their trauma team. Universally used criteria included penetrating injury to the head, neck or torso, limb amputation, spinal cord injury and systolic blood pressure <90 mmHg. Physiological limits for TTA varied between hospitals, with different limits for pulse rate and GCS used in different hospitals. All hospitals used mechanism of injury criteria alone as an activation prompt. CONCLUSIONS The criteria for TTA differ between hospitals within the same region. The criteria currently used will result in over-triage of trauma patients, but this might be of benefit in training the trauma team in centres that do not see a large volume of trauma patients. There are several advantages in standardization of criteria including optimization of patient care, training, research and audit. Further work is needed to validate existing criteria for use throughout the region.
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Affiliation(s)
- Jason Smith
- Department of Trauma, Liverpool Hospital, Liverpool, New South Wales, Australia.
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Abstract
BACKGROUND Trauma teams have been associated with improved survival probability of paediatric trauma patients. The present study seeks to estimate the use of trauma teams in Australian paediatric tertiary referral centres and describe their medical composition, leadership and criteria for activation. METHODS Australian paediatric tertiary referral centres were identified. A structured questionnaire assessing the presence, composition and means of activation of a trauma team was mailed to the 'Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. RESULTS Questionnaires were distributed to eight hospitals. Seventy-five per cent had an established trauma team. Hospitals without a trauma team claimed to have insufficient doctors to form a team and insufficient trauma caseload to justify a team. All trauma teams were potentially activated by prehospital paramedic data (field triage) and required a combination of anatomical, physiological and mechanistic criteria for activation. The two methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (66%) or a specific trauma pager (33%) carried by trauma team members. Fifty per cent of hospitals had a two-tier, stratified trauma team response. All teams consisted of emergency, surgical and intensive care unit registrars. Trauma team leaders were emergency medicine specialists/registrars (33%), surgical registrars (33%) and non-defined (33%). Consultant surgeons were not members of any trauma team. Eighty-three per cent of trauma teams consisted of more junior members after hours. Fifty per cent of hospitals did not have a surgical registrar on site outside of business hours. Eighty-eight per cent of hospitals engaged in some form of trauma audit. CONCLUSIONS Trauma teams are utilized by most Australian paediatric tertiary referral centres, with fairly uniform medical composition and criteria for activation. Paediatric surgeons presently have limited leadership roles and membership of Australian paediatric trauma teams.
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Affiliation(s)
- Kenneth Wong
- Department of Trauma, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Kühne CA, Ruchholtz S, Sauerland S, Waydhas C, Nast-Kolb D. [Personnel and structural requirements for the shock trauma room management of multiple trauma. A systematic review of the literature]. Unfallchirurg 2005; 107:851-61. [PMID: 15459805 DOI: 10.1007/s00113-004-0813-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of the study was the description of personal and structural preconditions essential for adequate diagnostic requirements and treatment in severely injured patients. Herein we give detailed information regarding both the composition and qualification of the trauma team and the activation criteria as well as instructions for the design of the emergency room and technical requirements. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). The trauma team should consist of (trauma) surgeons, anesthesiologists, radiologists, and one to two nursing staff members of each department. The attending physician should be present within 20 min. Trauma team activation criteria are among others: high energy/velocity trauma, penetrating injuries, GCS < or =14, and intubation. The emergency room should be integrated in the emergency department with all technical equipment being permanently available for optimal diagnostic and therapeutic management. A CT scanner should be positioned nearby.Adequate management of severely injured patients requires optimal personal and structural conditions. High costs and additional personnel are justified by improved quality of treatment.
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Affiliation(s)
- C A Kühne
- Klinik für Unfallchirurgie, Universitätsklinikum, Essen.
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Heetveld MJ, Harris I, Schlaphoff G, Sugrue M. Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg 2004; 74:520-9. [PMID: 15230782 DOI: 10.1111/j.1445-2197.2004.03074.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Haemodynamically unstable pelvic fracture patients have a high mortality, and decision-making is crucial. The present article discusses key clinical practice guidelines and options in the early management of these challenging patients. METHODS A multidisciplinary consensus committee developed guidelines following standard scientific methodology, comprehensive Medline searches and level of evidence grading. Clinical practice guidelines and options addressed four key questions: (i) how to determine the source of haemorrhage?; (ii) how to control haemorrhage?; (iii) what is the optimal angiography and embolization technique?; and (iv) what is the optimal pelvic stabilization technique? RESULTS The consensus best evidence recommends that the source of intra-abdominal haemorrhage should be assessed using diagnostic peritoneal aspiration and/or focused abdominal sonography in trauma within 30 min of patient arrival. Immediate laparotomy and concomitant pelvic stabilization control intra-abdominal haemorrhage and venous pelvic haemorrhage, followed by angiography if pelvic arterial bleeding is also present. If intra-abdominal bleeding is absent, non-invasive pelvic stabilization and transfer to angiography within 45 min of arrival is recommended to control venous and arterial pelvic haemorrhage. Optimal embolization is performed with steel coils or Gelfoam (Pharmacia & Upjohn, Peapack, NJ, USA) suspension. The optimal pelvic stabilization technique for rotationally unstable fractures with haemodynamic instability is non-invasive. CONCLUSION The consensus committee successfully developed best evidence recommendations identifying the issues and providing guidelines and options for this challenging condition.
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Affiliation(s)
- Martin J Heetveld
- Department of Trauma, Liverpool Health Service, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Trauma teams have been associated with improved trauma patient outcomes. The present study seeks to estimate the use of trauma teams in Australian hospitals and describe their medical composition, leadership and criteria for activation. METHODS Australian public hospitals with more than 100 beds, an emergency department and offering surgical services were identified. A survey assessing the presence, composition and means of activation of a trauma team was mailed to the 'Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. RESULTS Questionnaires were distributed to 130 hospitals. After exclusion of hospitals that did not receive patients with traumatic injuries, and dedicated paediatric tertiary referral centres, 111 hospitals remained for analysis. Of these, 56% had an established trauma team, while 71% of hospitals without a trauma team claimed to have insufficient doctors to form one team. Ninety-five per cent of trauma teams were potentially activated by prehospital paramedic data (field triage). For 92% of trauma teams a combination of anatomical, physiological and mechanistic criteria were required for activation. The most common methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (31%) or by paging trauma team members individually (31%). Fifty-eight per cent of trauma team leaders were emergency medicine specialists/registrars, while 8% of trauma teams were led by surgeons/registrars. Consultant surgeons were members of 23% of trauma teams and 74% of trauma teams consisted of more junior members after hours. Some form of trauma audit was engaged in by 64% of hospitals. CONCLUSIONS Trauma teams are yet to be utilized by many Australian hospitals that provide trauma care. Australian surgeons presently have limited leadership roles and membership in trauma teams. Trauma audit can be more widely adopted in Australian hospitals.
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Affiliation(s)
- Kenneth Wong
- Department of Trauma, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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D'Amours SK, Sugrue M, Deane SA. Initial management of the poly-trauma patient: a practical approach in an Australian major trauma service. Scand J Surg 2002; 91:23-33. [PMID: 12075831 DOI: 10.1177/145749690209100105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The initial management of the poly-trauma patient is of vital importance to minimizing both patient morbidity and mortality. We present a practical approach to the early management of a severely injured patient as practiced at Liverpool Hospital in Sydney, Australia. Specific attention is paid to innovations in care and specific controversies in early management as well as local solutions to challenging problems.
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Affiliation(s)
- S K D'Amours
- Department of Trauma Surgery, Liverpool Hospital, Sydney, Australia
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Kobusingye OC, Guwatudde D, Owor G, Lett RR. Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev 2002; 8:133-6. [PMID: 12120832 PMCID: PMC1730841 DOI: 10.1136/ip.8.2.133] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe injuries and their emergency care at five city hospitals. SETTING Data were collected between January and December 1998 from casualty departments of the five largest hospitals of Kampala city, Uganda, with bed capacity ranging from 60 to 1200. METHODS Registry forms were completed on trauma patients. All patients with injuries were eligible. Outcome at two weeks was determined for admitted patients. RESULTS Of the 4359 injury patients, 73% were males. Their mean age was 24.2 years, range 0.1-89, and a 5-95 centile of 5-50 years. Patients with injuries were 7% of all patients seen. Traffic crashes caused 50% of injuries, and were the leading cause for patients > or = 10 years. Fifty eight per cent of injuries occurred on the road, 29% at home, and 4% in a public building. Falls, assaults, and burns were the main causes in homes. Fourteen per cent of injuries were intentional. Injuries were severe in 24% as determined with the Kampala trauma score. One third of patients were admitted; two thirds arrived at the hospital within 30 minutes of injury, and 92% were attended within 20 minutes of arrival. CONCLUSIONS Injuries in Kampala are an important public health problem, predominantly in young adult males, mostly due to traffic. The majority of injuries are unintentional. Hospital response is rapid, but the majority of injuries are minor. Without pre-hospital care, it is likely that patients with serious injuries die before they access care. Preventive measures and a pre-hospital emergency service are urgently needed.
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Affiliation(s)
- O C Kobusingye
- Department of Surgery, Faculty of Medicine, Makerere University and Injury Control Centre, Kampala, Uganda.
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