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Lee ZX, Lim XT, Ang E, Hajibandeh S, Hajibandeh S. The effect of preinjury anticoagulation on mortality in trauma patients: A systematic review and meta-analysis. Injury 2020; 51:1705-1713. [PMID: 32576378 DOI: 10.1016/j.injury.2020.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the effect of preinjury anticoagulation on mortality in trauma patients. METHODS A search of electronic information sources was conducted to identify all observational studies comparing preinjury anticoagulation with no preinjury anticoagulation in trauma patients. The primary outcome measure was overall mortality (overall mortality, in-hospital mortality and 30-day mortality). The secondary outcome measures included the length of hospital stay, length of intensive care unit (ICU) stay, incidence of intracranial haemorrhage (ICH), and need for operation. Fixed effect or random effects modelling was applied as appropriate to calculate pooled outcome data. RESULTS Nineteen comparative studies enrolling a total of 1,365,446 patients were included. Preinjury anticoagulation was associated with higher risk of overall mortality (OR 2.12, 95%CI 1.79 - 2.51, p < 0.00001), in-hospital mortality (OR 2.04, 95%CI 1.66 - 2.52, p < 0.00001), ICH (OD 1.99, 95%CI 1.61 - 2.45, p < 0.00001), and shorter length of hospital stay (MD 0.50, 95%CI 0.03 - 0.97, p = 0.04) in comparison to no preinjury anticoagulation. We found no difference between the two groups in 30-day mortality (OR 1.61, 95%CI 0.91 - 2.85, p = 0.10), length of ICU stay (MD 0.62, 95%CI -0.13 - 1.36, p = 0.11), and need for operation (OR 1.73, 95%CI 0.71 - 4.20, p = 0.23). The quality of the available evidence was moderate. CONCLUSION Preinjury anticoagulation is a significant predictor of mortality in trauma patients. Future studies should focus on strategies required to reduce such a significant risk of mortality in these high-risk patients. This may include adaptation of primary, secondary and tertiary trauma surveys for patients on preinjury anticoagulation.
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Affiliation(s)
- Zong Xuan Lee
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Croesnewydd Road, Wrexham, LL13 7TD, United Kingdom.
| | - Xin Tian Lim
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Croesnewydd Road, Wrexham, LL13 7TD, United Kingdom
| | - Eshen Ang
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Croesnewydd Road, Wrexham, LL13 7TD, United Kingdom
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Shahab Hajibandeh
- Department of General Surgery, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, United Kingdom
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Vest JR, Kirk HM, Issel LM. Quality and integration of public health information systems: A systematic review focused on immunization and vital records systems. Online J Public Health Inform 2012; 4:ojphi.v4i2.4198. [PMID: 23569634 PMCID: PMC3615811 DOI: 10.5210/ojphi.v4i2.4198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective. METHODS A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality. RESULTS Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors. CONCLUSIONS For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies.
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Affiliation(s)
| | - Hilary M Kirk
- University of Illinois at Chicago, School of Public Health, Chicago, IL
| | - L Michele Issel
- University of Illinois at Chicago, School of Public Health, Chicago, IL
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Tinetti ME, McAvay GJ, Murphy TE, Gross CP, Lin H, Allore HG. Contribution of individual diseases to death in older adults with multiple diseases. J Am Geriatr Soc 2012; 60:1448-56. [PMID: 22734792 PMCID: PMC3419332 DOI: 10.1111/j.1532-5415.2012.04077.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine empirically the diseases contributing most commonly and strongly to death in older adults, accounting for coexisting diseases. DESIGN Longitudinal. SETTING United States. PARTICIPANTS Twenty-two thousand eight hundred ninety Medicare Current Beneficiary Survey participants, a national representative sample of Medicare beneficiaries, enrolled during 2002 to 2006. MEASUREMENTS Information on chronic and acute diseases was ascertained from Medicare claims data. Diseases contributing to death during follow-up were identified empirically using regression models for all diseases with a frequency of 1% or greater and hazard ratio for death of greater than 1. The additive contributions of these diseases, adjusting for coexisting diseases, were calculated using a longitudinal extension of average attributable fraction; 95% confidence intervals were estimated from bootstrapping. RESULTS Fifteen diseases and acute events contributed significantly to death, together accounting for nearly 70% of death. Heart failure (20.0%), dementia (13.6%), chronic lower respiratory disease (12.4%), and pneumonia (5.3%) made the largest contributions to death. Cancer, including lung, colorectal, lymphoma, and head and neck, together contributed to 5.6% of death. Other diseases and events included acute kidney injury, stroke, septicemia, liver disease, myocardial infarction, and unintentional injuries. CONCLUSION The use of methods that focus on determining a single underlying cause may lead to underestimation of the extent of the contribution of some diseases such as dementia and respiratory disease to death in older adults and overestimation of the contribution of other diseases. Current conceptualization of a single underlying cause may not account adequately for the contribution to death of coexisting diseases that older adults experience.
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Affiliation(s)
- Mary E. Tinetti
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Yale School of Public Health, New Haven, CT 06520
| | - Gail J. McAvay
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Haiqun Lin
- Yale School of Public Health, New Haven, CT 06520
| | - Heather G. Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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Earle-Richardson GB, Jenkins PL, Scott EE, May JJ. Improving agricultural injury surveillance: a comparison of incidence and type of injury event among three data sources. Am J Ind Med 2011; 54:586-96. [PMID: 21538445 DOI: 10.1002/ajim.20960] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Agriculture ranks as one of the most hazardous industries in the nation. Ongoing injury surveillance is key to identifying and preventing major sources of injury. OBJECTIVE The objective of this study was to compare the total number and types of injuries identified from community reporting versus two newly available medical data systems. These new systems are important because they are less time consuming and expensive to maintain. METHOD Farm injury case records from 2007 were collected for 10 NY counties from the following sources: ambulance reports, hospital data, and community surveillance data. RESULTS For the 107 ambulance report cases, horses (35%), tractors (15%), and livestock (10%) were the three leading injury sources. For the 261 hospital cases, the leading sources were hand tools (24%), farmstead machinery (23%), and buildings/structures/surfaces (22%). Tractor injuries (37%) were the most common source of injuries identified by the 44 community surveillance cases. Struck by object was the most frequent injury event type for hospital and surveillance data (34%, 30%). Falls were the highest category for ambulance reports (36%) and were also common for hospital data (29%). Nine of the 11 fatal cases were found through community surveillance. CONCLUSION Ambulance reports and hospital data contribute a large number of additional farm injury cases to existing surveillance data. From these cases, horse injuries, falls, and hand tool injuries appear to play a larger role in farm injuries. Future research should explore how to best use these electronic resources for agricultural injury surveillance.
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Affiliation(s)
- Giulia B Earle-Richardson
- The New York Center for Agricultural Medicine and Health, Bassett Healthcare Network, Cooperstown, USA
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Zehtabchi S, Nishijima DK, McKay MP, Mann NC. Trauma registries: history, logistics, limitations, and contributions to emergency medicine research. Acad Emerg Med 2011; 18:637-43. [PMID: 21676063 DOI: 10.1111/j.1553-2712.2011.01083.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Trauma registries have been designed to serve a number of purposes, including quality improvement, injury prevention, clinical research, and policy development. Since their inception over 30 years ago, there are increasingly more institutions with trauma registries, many of which submit data to a national trauma registry. The goal of this review is to describe the history, logistics, and characteristics of trauma registries and their contribution to emergency medicine and trauma research. Discussed in this review are the limitations of trauma registries, such as variability in quality and type of the collected data, absence of data pertaining to long-term and functional outcomes, prehospital information, and complications as well as other methodologic obstacles limiting the utility of registry data in clinical and epidemiologic research.
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Affiliation(s)
- Shahriar Zehtabchi
- Department of Emergency Medicine, Downstate Medical Center and Kings County Hospital, Brooklyn, NY, USA.
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Mears G, Mann NC, Wright D, Schnyder ME, Dean JM. Validation of a Predictive Model for Automated External Defibrillator Placement in Rural America. PREHOSP EMERG CARE 2009; 10:186-93. [PMID: 16531375 DOI: 10.1080/10903120500541241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The development of Automated External Defibrillators (AEDs) to treat out-of-hospital cardiac arrest (OOHCA) has greatly expanded the availability of life saving defibrillatory shocks in various settings. However, placement of AEDs in rural areas remains perplexing since OOHCAs are rare and unpredictable. We set out to develop a cost-effective rural AED placement model and to test the validity of the resulting model using OOHCAs attended by EMS. METHODS DESIGN A population-based cross-sectional study. Analytic Plan: An exhaustive literature search was conducted to identify community attributes correlated with successful placement of AEDs in rural regions. Identified attributes were characterized using U.S. Census and CDC heart disease mortality data to estimate the potential risk for AED use and applied this estimate to rural census tracts in all 50 states. Based upon risk, AEDS were assigned to each tract using a first responder model and cost effectiveness was assessed. Using Utah State EMS data, the predicted placement of AEDs in each tract was validated using the actual number of OOHCAs attended by EMS. RESULTS A total of 14,586 rural census tracts in 50 U.S. states were evaluated. On average, 2,600 AEDs were situated within each state. AED placement in rural areas proved as cost effective as health screening programs. In Utah, predicted AED placement correlated with the frequency of OOHCAs attended by EMS personnel (rho= 0.55, p < 0.001). CONCLUSIONS The resulting model illustrates one potential way to determine the most beneficial location for rural AED placement.
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Affiliation(s)
- Greg Mears
- Department of Emergency Medicine, University of North Carolina, Chapel Hill 27599-7594, USA.
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Abstract
BACKGROUND We aim to assess the long-term trend of and identify risk factors for traumatic spinal cord injury (TSCI) mortality from 1981 through 1998 in the state of South Carolina (SC). METHODS We analyzed data from the TSCI surveillance system in SC. Poisson regression analyses were used to examine trends in TSCI mortality rates across subpopulations of interest. Multiple logistic regression was used to identify risk factors for TSCI mortality. RESULTS The rate of TSCI mortality was 27.4 per million population between 1981 and 1998. A significant 3% annual decrease in the TSCI mortality rate was found from 1981 through 1998. Specifically, TSCI mortality rates declined the most per year in motor vehicle crashes, males, and whites. Adjusted for covariates, individuals of older ages, black race, with a cervical TSCI, and with a more severe injury, as defined by both Frankel grade and Abbreviated Injury Scale, were associated with higher odds of in-hospital mortality. Females had lower odds of in-hospital mortality than males. CONCLUSION Although mortality rate is decreasing, TSCI remains a significant public health problem, with SC having higher rates of TSCI mortality than the United States. The association between gender and in-hospital mortality needs further exploration.
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Zitnay GA, Zitnay KM, Povlishock JT, Hall ED, Marion DW, Trudel T, Zafonte RD, Zasler N, Nidiffer FD, DaVanzo J, Barth JT. Traumatic brain injury research priorities: the Conemaugh International Brain Injury Symposium. J Neurotrauma 2009; 25:1135-52. [PMID: 18842105 DOI: 10.1089/neu.2008.0599] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In 2005, an international symposium was convened with over 100 neuroscientists from 13 countries and major research centers to review current research in traumatic brain injury (TBI) and develop a consensus document on research issues and priorities. Four levels of TBI research were the focus of the discussion: basic science, acute care, post-acute neurorehabilitation, and improving quality of life (QOL). Each working group or committee was charged with reviewing current research, discussion and prioritizing future research directions, identifying critical issues that impede research in brain injury, and establishing a research agenda that will drive research over the next five years, leading to significantly improved outcomes and QOL for individuals suffering brain injuries. This symposium was organized at the request of the Congressional Brain Injury Task Force, to follow up on the National Institutes of Health Consensus Conference on TBI as mandated by the TBI ACT of 1996. The goal was to review what progress had been made since the National Institutes of Health (NIH) Consensus Conference, and also to follow up on the 1990's Decade of the Brain Project. The major purpose of the symposium was to provide recommendations to the U.S. Congress on a priority basis for research, treatment, and training in TBI over the next five years.
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Affiliation(s)
- George A Zitnay
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Skaga NO, Eken T, Jones JM, Steen PA. Different definitions of patient outcome: consequences for performance analysis in trauma. Injury 2008; 39:612-22. [PMID: 18377909 DOI: 10.1016/j.injury.2007.11.426] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 11/15/2007] [Accepted: 11/26/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND Death during acute care hospitalisation is commonly used as a principal outcome indicator in injury research. This endpoint excludes post-hospital trauma-related deaths, which are substantial according to recent US studies. Two additional ways of defining outcome in trauma victims are also used; by end of somatic care, and at 30 days after injury. Our primary aim was to analyse how the different definitions of trauma outcome influence performance analyses. Secondly, we wanted to evaluate whether 30 days mortality after injury, which is widely used in other parts of biomedicine and recommended by the United Nations for use in transport statistics, is a suitable endpoint in trauma research. MATERIALS AND METHODS We conducted a retrospective analysis of prospectively collected data from the hospital based trauma registry at Ulleval University Hospital (UUH) in Oslo, Norway. Outcome measure was mortality at discharge from UUH, i.e., by "end of acute care", at end of somatic care defined as discharge from final acute care hospital, and at 30 days after injury. Analyses were performed according to conventional TRISS methodology. RESULTS 3332 of 3446 patients from the years 2000-2004 were included. Of these, 323 (9.7%) died within 30 days of injury or during somatic care more than 30 days after injury. Mortality varied with outcome definition, with 264 deaths (81.7% of total deaths) before discharge from UUH, 318 (98.4%) before end of somatic care, and 308 (95.4%) within 30 days after injury. TRISS-based trauma system performance evaluation for blunt trauma showed significantly better outcome than predicted with discharge from UUH as outcome definition, whereas for category 30 days after injury, performance was clearly less favourable. Performance for penetrating trauma was not affected, since all deaths occurred before 30 days, and nearly all before discharge from UUH. CONCLUSIONS A substantial number of in-hospital deaths following blunt trauma occurs after discharge from the primary institution, i.e., unnoticed when "end of acute care" is used as outcome definition. Consequently, outcome definition influenced performance when comparing our institution to an acknowledged standard. We recommend mortality occurring within 30 days of injury as endpoint in trauma research.
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Affiliation(s)
- Nils O Skaga
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway.
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Cameron CM, Kliewer EV, Purdie DM, McClure RJ. Long-term mortality following injury in working-age adults: a systematic review. Int J Inj Contr Saf Promot 2007; 14:11-8. [PMID: 17624006 DOI: 10.1080/17457300600890103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Priorities for prevention activities and planning for services depend on comprehensive knowledge of the distribution of the injury-related burden in the community. The aim of this systematic review was to quantify the effect of being injured, compared with not being injured, on long-term mortality in working age adults. Cohort studies were selected that were population-based, measured mortality post-discharge from inpatient treatment, included a non-injured comparison group and related to working-age adults. Data synthesis was in tabular and text form with a meta-analysis not being possible because of the heterogeneity between studies. Eleven studies met the inclusion criteria. All studies found an overall positive association between injury and increased mortality. While the greatest excess mortality was evident during the initial period post-injury, increased mortality was shown in some studies to persist for up to 40 years after injury. Due to the limited number of injury types studied and heterogeneity between studies, there is insufficient published evidence on which to calculate population estimates of long-term mortality, where injury is a component cause. The review does suggest there is considerable excess mortality following injury that is not accounted for in current methods of quantifying injury burden, and is not used to assess quality and effectiveness of trauma care.
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Affiliation(s)
- C M Cameron
- School of Medicine, Griffith University, Logan, Australia.
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Abstract
Emergency medicine plays a significant role in injury prevention through the use of public health models that link injury data to prevention programming, research, and advocacy. The day-to-day experiences in the emergency department provide a picture of the injury problem in a given community and give the emergency practitioner a real-world basis for injury prevention efforts. This article covers the basics or injury prevention, including defining the problem, discussing data and conceptual aspects of injury prevention, and systematically identifying successful approach to reducing the burden of injuries.
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Affiliation(s)
- Linda C Degutis
- Section of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.
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Koehler SA. Using medical examiner/coroner-generated Death Certificates in research: advantages and limitations. JOURNAL OF FORENSIC NURSING 2005; 1:133-5. [PMID: 17073047 DOI: 10.1111/j.1939-3938.2005.tb00032.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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