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Wah W, Berecki-Gisolf J, Walker-Bone K. In-hospital complications of work-related musculoskeletal injuries. Injury 2024; 55:111211. [PMID: 37984014 DOI: 10.1016/j.injury.2023.111211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND, OBJECTIVES Work-related musculoskeletal (MSK) injuries are a major contributor to morbidity worldwide and frequently result in hospitalisation. Hospital complications are common, costly, and largely preventable, but relevant data is required to address this. This study aimed to identify the incidence and factors associated with in-hospital complications of work-related MSK injuries. METHODS This study is based on work-related MSK hospital admission data from Victorian Admitted Episodes Database, 2016-2022. Complications were identified based on ICD-10-AM coding using CHADx (Classification of Hospital Acquired Diagnoses). Negative binomial and logistic regression analyses were performed to identify factors related to in-hospital complications. RESULTS In-hospital complications occurred in 6.3 % of work-related MSK injury admissions. In the adjusted models, ages ≥45 years, female sex, and area-level disadvantage were associated with in-hospital complications. Stay at public (vs private) hospitals, comorbidity, emergency admissions, and general anaesthesia were also associated. Complication rates were higher in hospitalised workers with direct head, neck, and trunk injuries and cumulative MSK disorders than those with direct extremities injuries and acute MSK conditions. The most common complications were cardiovascular, gastrointestinal complications and adverse drug events. CONCLUSION This study identified patient, injury and hospital-related characteristics associated with in-hospital complications of work-related MSK injuries for informing prevention strategies and risk estimation by hospital staff and workers' compensation schemes. The results demonstrate a sizable rate of complications given the relatively young and healthy study population.
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Affiliation(s)
- Win Wah
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia.
| | - Janneke Berecki-Gisolf
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia; Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, 21 Alliance Ln, Clayton, Melbourne, Victoria 3168, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia
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Moore L, Freire G, Turgeon AF, Bérubé M, Boukar KM, Tardif PA, Stelfox HT, Beno S, Lauzier F, Beaudin M, Zemek R, Gagnon IJ, Beaulieu E, Weiss MJ, Carsen S, Gabbe B, Stang A, Ben Abdeljelil A, Gnanvi E, Yanchar N. Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2334266. [PMID: 37721752 PMCID: PMC10507486 DOI: 10.1001/jamanetworkopen.2023.34266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Importance Adult trauma centers (ATCs) have been shown to decrease injury mortality and morbidity in major trauma, but a synthesis of evidence for pediatric trauma centers (PTCs) is lacking. Objective To assess the effectiveness of PTCs compared with ATCs, combined trauma centers (CTCs), or nondesignated hospitals in reducing mortality and morbidity among children admitted to hospitals following trauma. Data Sources MEDLINE, Embase, and Web of Science through March 2023. Study Selection Studies comparing PTCs with ATCs, CTCs, or nondesignated hospitals for pediatric trauma populations (aged ≤19 years). Data Extraction and Synthesis This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis and Meta-analysis of Observational Studies in Epidemiology guidelines. Pairs of reviewers independently extracted data and evaluated risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. A meta-analysis was conducted if more than 2 studies evaluated the same intervention-comparator-outcome and controlled minimally for age and injury severity. Subgroup analyses were planned for age, injury type and severity, trauma center designation level and verification body, country, and year of conduct. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence. Main Outcome(s) and Measure(s) Primary outcomes were mortality, complications, functional status, discharge destination, and quality of life. Secondary outcomes were resource use and processes of care, including computed tomography (CT) and operative management of blunt solid organ injury (SOI). Results A total of 56 studies with 286 051 participants were included overall, and 34 were included in the meta-analysis. When compared with ATCs, PTCs were associated with a 41% lower risk of mortality (OR, 0.59; 95% CI, 0.46-0.76), a 52% lower risk of CT use (OR, 0.48; 95% CI, 0.26-0.89) and a 64% lower risk of operative management for blunt SOI (OR, 0.36; 95% CI, 0.23-0.57). The OR for complications was 0.80 (95% CI, 0.41-1.56). There was no association for mortality for older children (OR, 0.71; 95% CI, 0.47-1.06), and the association was closer to the null when PTCs were compared with CTCs (OR, 0.73; 95% CI, 0.53-0.99). Results remained similar for other subgroup analyses. GRADE certainty of evidence was very low for all outcomes. Conclusions and Relevance In this systematic review and meta-analysis, results suggested that PTCs were associated with lower odds of mortality, CT use, and operative management for SOI than ATCs for children admitted to hospitals following trauma, but certainty of evidence was very low. Future studies should strive to address selection and confounding biases.
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Affiliation(s)
- Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
- Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada
| | - Gabrielle Freire
- Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexis F. Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
- Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Khadidja Malloum Boukar
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
| | - Henry T. Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Beno
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
- Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Marianne Beaudin
- Sainte-Justine Hospital, Department of Paediatric Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Roger Zemek
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Isabelle J. Gagnon
- Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal Children’s Hospital, Montréal, Québec, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Emilie Beaulieu
- Département de pédiatrie, Faculté de médecine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Matthew John Weiss
- Centre Mère-Enfant Soleil du CHU de Québec, Transplant Québec, Québec, Québec, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Antonia Stang
- Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anis Ben Abdeljelil
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
| | - Eunice Gnanvi
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
| | - Natalie Yanchar
- Department of Surgery, University of Calgary, Calgary, Canada
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Lopes MCBT, Bustillo RA, Whitaker IY. In-hospital complications after trauma due to road traffic accidents. Eur J Trauma Emerg Surg 2023; 49:1855-1862. [PMID: 37017763 DOI: 10.1007/s00068-023-02264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity. METHODS This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality. RESULTS Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality. CONCLUSION Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge.
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Affiliation(s)
| | | | - Iveth Yamaguchi Whitaker
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Rua Napoleão de Barros, 754, Sao Paulo, SP, CEP: 04024-002, Brazil
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Computed tomographic bone mineral density is independently associated with adverse in-hospital outcomes in Dutch level-1 trauma patients. Eur J Trauma Emerg Surg 2022; 49:1393-1400. [DOI: 10.1007/s00068-022-02175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
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Idriss-Hassan A, Bérubé M, Belcaïd A, Clément J, Bourgeois G, Rizzo C, Neveu X, Soltana K, Thakore J, Moore L. Derivation and validation of actionable quality indicators targeting reductions in complications for injury admissions. Eur J Trauma Emerg Surg 2021; 48:1351-1361. [PMID: 33961073 DOI: 10.1007/s00068-021-01681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Approximately, one out of five patients hospitalized following injury will develop at least one hospital complication, more than three times that observed for general admissions. We currently lack actionable Quality Indicators (QI) targeting specific complications in this population. We aimed to derive and validate QI targeting hospital complications for injury admissions and develop algorithms to identify patient charts to review. METHODS We conducted a retrospective cohort study including patients with major trauma admitted to any level I or II adult trauma center an integrated Canadian trauma system (2014-2019). We used the trauma registry to develop five QI targeting deep vein thrombosis/pulmonary embolism (DVT/PE), decubitus ulcers, delirium, pneumonia and urinary tract infection (UTI). We developed algorithms to identify patient charts to revise on consultation with a group of clinical experts. RESULTS The study population included 14,592 patients of whom 5.3% developed DVT or PE, 2.7% developed a decubitus ulcer, 8.6% developed delirium, 14.7% developed pneumonia and 7.3% developed UTI. The indicators demonstrated excellent predictive performance (Area Under the Curve 0.81-0.87). We identified 4 hospitals with a higher than average incidence of at least one of the targeted complications. The algorithms identified on average 50 and 20 charts to be reviewed per year for level I and II centers, respectively. CONCLUSION In line with initiatives to improve the quality of trauma care, we propose QI targeting reductions in hospital complications for injury admissions and algorithms to generate case lists to facilitate the review of patient charts.
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Affiliation(s)
- Abakar Idriss-Hassan
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.,Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Mélanie Bérubé
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.,Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Amina Belcaïd
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.,Institut national d'excellence en santé et en services sociaux, Québec, QC, Canada
| | - Julien Clément
- Institut national d'excellence en santé et en services sociaux, Québec, QC, Canada.,Department of Surgery, Université Laval, Québec, QC, Canada
| | | | - Christine Rizzo
- Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Xavier Neveu
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Kahina Soltana
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Jaimini Thakore
- Provincial Lead, Data, Evaluation and Analytics, Trauma Services BC, British Columbia, Canada
| | - Lynne Moore
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. .,Department of Social and Preventative Medicine, Université Laval, 2325, Rue de l'Université, Québec, QC, G1V 0A6, Canada.
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study. PLoS One 2020; 15:e0238182. [PMID: 32915808 PMCID: PMC7485849 DOI: 10.1371/journal.pone.0238182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients. Methods Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states. Results Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI. Conclusions Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
- * E-mail:
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. Complications, burden and in-hospital death among hospital treated injury patients in Victoria, Australia: a data linkage study. BMC Public Health 2019; 19:798. [PMID: 31226975 PMCID: PMC6588941 DOI: 10.1186/s12889-019-7080-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background A wide range of outcome measures can be calculated for hospital-treated injury patients. These include mortality, use of critical care services, complications, length of stay, treatment costs, readmission and nursing care after discharge. Each address different aspects and phases of injury recovery and can yield vastly different results. This study aims to: (1) measure and report this range of outcomes in hospital-treated injury patients in a defined population; and (2) describe the associations between injury characteristics, socio-demographics and comorbidities and the various outcomes. Methods A retrospective analysis was conducted of injury-related hospital admissions from July 2012 to June 2014 (152,835 patients) in Victoria, Australia. The admission records were linked within the dataset, enabling follow-up, to assess the outcomes of in-hospital death, burden, complications and 30-day readmissions. Associations between factors and outcomes were determined using univariate regression analysis. Results The proportion of patients who died in hospital was 0.9%, while 26.8% needed post-discharge care. On average patients had 2.4 complications (confidence interval (CI) 2.4–2.5) related to their initial injury, the mean cost of treating a patient was Australian dollars 7013 (CI 6929–7096) and the median length of stay was one day (inter quartile range 1–3). Intensive-care-unit-stay was recorded in 3% of the patients. All-cause 30-day readmissions occurred in 12.3%, non-planned 30-day readmissions in 7.9%, while potentially avoidable 30-day readmissions were observed in 3.2% of the patients. Increasing age was associated with all outcomes. The need for care post-discharge from hospital was highest among children and the oldest age group (85 years and over). Injury severity was associated with all adverse outcomes. Increasing number of comorbidities increased the likelihood of all outcomes. Overall, outcomes are shown to differ by age, gender, comorbidities, body region injured, injury type and injury severity, and to a lesser extent by socio-economic areas. Conclusions Outcomes and risk factors differ depending on the outcome measured, and the method used for measuring the outcome. Similar outcomes measured in different ways produces varying results. Data linkage has provided a valuable platform for a comprehensive overview of outcomes, which can help design and target secondary and tertiary preventive measures. Electronic supplementary material The online version of this article (10.1186/s12889-019-7080-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia.
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, 50 Lonsdale Street, Melbourne, Victoria, 3000, Australia
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Quality and Patient Safety Indicators in Trauma and Emergency Surgery: National and Global Considerations. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0110-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Hospital and Intensive Care Unit Length of Stay for Injury Admissions: A Pan-Canadian Cohort Study. Ann Surg 2017; 267:177-182. [PMID: 27735821 DOI: 10.1097/sla.0000000000002036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the variation in hospital and intensive care unit (ICU) length of stay (LOS) for injury admissions across Canadian provinces and to evaluate the relative contribution of patient case mix and treatment-related factors (intensity of care, complications, and discharge delays) to explaining observed variations. BACKGROUND Identifying unjustified interprovider variations in resource use and the determinants of such variations is an important step towards optimizing health care. METHODS We conducted a multicenter, retrospective cohort study on admissions for major trauma (injury severity score >12) to level I and II trauma centers across Canada (2006-2012). We used data from the Canadian National Trauma Registry linked to hospital discharge data to compare risk-adjusted hospital and ICU LOS across provinces. RESULTS Risk-adjusted hospital LOS was shortest in Ontario (10.0 days) and longest in Newfoundland and Labrador (16.1 days; P < 0.001). Risk-adjusted ICU LOS was shortest in Québec (4.4 days) and longest in Alberta (6.1 days; P < 0.001). Patient case-mix explained 32% and 8% of interhospital variations in hospital and ICU LOS, respectively, whereas treatment-related factors explained 63% and 22%. CONCLUSIONS We observed significant variation in risk-adjusted hospital and ICU LOS across trauma systems in Canada. Provider ranks on hospital LOS were not related to those observed for ICU LOS. Treatment-related factors explained more interhospital variation in LOS than patient case-mix. Results suggest that interventions targeting reductions in low-value procedures, prevention of adverse events, and better discharge planning may be most effective for optimizing LOS for injury admissions.
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Abstract
Complications in hospitalized trauma patients are major causes of morbidity and mortality. The aims of this study were to identify the in-hospital trauma patients' complications and identify the risk factors for complications in this population. A retrospective analysis was conducted in a sample from a Brazilian hospital. The sample consisted of 407 patients, 194 (47.66%) of whom had records of complications. The most common complications were infections (41.80%). The risk factors related to the complications were age, length of hospital stay, external causes, and injury severity. The complications were frequent in this sample, and the risk for complications was characterized by multiple factors.
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SHAPING QUALITY THROUGH VISION, STRUCTURE, AND MONITORING OF PERFORMANCE AND QUALITY INDICATORS: IMPACT STORY FROM THE QUEBEC TRAUMA NETWORK. Int J Technol Assess Health Care 2017; 33:415-419. [DOI: 10.1017/s0266462317000198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: The Quebec Trauma Care Continuum (TCC) was initiated in 1991 with the objective of providing accessible, continuous, efficient, and high quality services for all injury cases in the province.Methods: The TCC design relied on three key components: (i) the designation of a network of acute care and rehabilitation facilities with specific mandates and responsibilities; (ii) the elaboration of transfer protocols, standing agreements, and governing structures to ensure fluid and optimal patient flow; and (iii) the close monitoring of several indicators to facilitate the continuous evaluation and improvement of the network.Results: Between 1992 and 2002, in-hospital mortality following major trauma decreased from 51.8 percent to 8.6 percent, followed by an additional 24 percent drop between 1999 and 2012. We also observed a 16 percent decrease in average LOS but no change in the incidence of complications or unplanned readmissions. These changes translate into 186 lives saved per year and cost savings, due to shorter LOS, of 6.3 million CD$ per year. The risk-adjusted incidence of in-hospital mortality following major injury between 2006 and 2012 (7 percent) was the lowest of all Canadian provinces.Conclusions: Strategic transformation of a network's structure and processes, supported by continuous monitoring of validated quality indicators, can lead to significant and sustainable improvements in clinical outcomes. It is hoped that the Quebec trauma story will inspire other jurisdictions and other healthcare sectors.
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Complications following hospital admission for traumatic brain injury: A multicenter cohort study. J Crit Care 2017; 41:1-8. [PMID: 28477507 DOI: 10.1016/j.jcrc.2017.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/11/2017] [Accepted: 04/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the incidence, determinants and impact on outcome of in-hospital complications in adults with traumatic brain injury (TBI). MATERIALS AND METHODS We conducted a multicenter cohort study of TBI patients admitted between 2007 and 2012 in an inclusive Canadian trauma system. Risk ratios of complications, odds ratios of mortality and geometric mean ratios of length of stay (LOS) were calculated using generalized linear models with adjustment for prognostic indicators and hospital cluster effects. RESULTS Of 12,887 patients, 3.2% had at least one neurological complication and 22.6% a non-neurological complication. Mechanical ventilation, head injury severity, blood transfusion and neurosurgical intervention had the strongest correlation with neurological complications. Mechanical ventilation, the Glasgow Coma Scale, blood transfusion and concomitant injuries had the strongest correlation with non-neurological complications. Neurological and non-neurological complications were associated with a 85% and 53% increase in the odds of mortality, and a 60% and two-fold increases in LOS, respectively. CONCLUSIONS More than 20% of patients with TBI developed a complication. Many of these complications were associated with increased mortality and LOS. Results highlight the importance of prevention strategies adapted to treatment decisions and underline the need to improve knowledge on the underuse and overuse of clinical interventions.
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Dufresne P, Moore L, Tardif PA, Razek T, Omar M, Boutin A, Clément J. Impact of trauma centre designation level on outcomes following hemorrhagic shock: a multicentre cohort study. CANADIAN JOURNAL OF SURGERY. JOURNAL CANADIEN DE CHIRURGIE 2017; 60:45-52. [PMID: 28234589 DOI: 10.1503/cjs.009916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hemorrhagic shock is responsible for 45% of injury fatalities in North America, and 50% of these occur within 2 h of injury. There is currently a lack of evidence regarding the trajectories of patients in hemorrhagic shock and the potential benefit of level I/II care for these patients. We aimed to compare mortality across trauma centre designation levels for patients in hemorrhagic shock. Secondary objectives were to compare surgical delays, complications and hospital length of stay (LOS). METHODS We performed a retrospective cohort study based on a Canadian inclusive trauma system (1999-2012), including adults with systolic blood pressure (SBP) < 90 mm Hg on arrival who required urgent surgical care (< 6 h). Logistic regression was used to examine the influence of trauma centre designation level on risk-adjusted surgical delays, mortality and complications. Linear regression was used to examine LOS. RESULTS Compared with level I centres, adjusted odds ratios (and 95% confidence intervals [CI]) of mortality for level III and IV centres were 1.71 (1.03-2.85) and 2.25 (1.08-4.73), respectively. Surgical delays did not vary across designation levels, but mean LOS and complications were lower in level II-IV centres than level I centres. CONCLUSION Level I/II centres may offer a survival advantage over level III/IV centres for patients requiring emergency intervention for hemorrhagic shock. Further research with larger sample sizes is required to confirm these results and to identify optimal transport time thresholds for bypassing level III/IV centres in favour of level I/II centres.
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Affiliation(s)
- Philippe Dufresne
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
| | - Lynne Moore
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
| | - Pier-Alexandre Tardif
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
| | - Tarek Razek
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
| | - Madiba Omar
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
| | - Amélie Boutin
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
| | - Julien Clément
- From the Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, CHU de Québec, Université Laval Research Centre, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Social and Preventive Medicine, Université Laval, Québec, Que., (Dufresne, Moore, Tardif, Omar, Boutin); the Department of Sugery, McGill University, Montreal, Que., (Razek); and the Department of Surgery, Université Laval, Québec, Que. (Clément)
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Boutin A, Moore L, Lauzier F, Chassé M, English S, Zarychanski R, McIntyre L, Griesdale D, Fergusson DA, Turgeon AF. Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study. BMJ Open 2017; 7:e014472. [PMID: 28360248 PMCID: PMC5372060 DOI: 10.1136/bmjopen-2016-014472] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Optimisation of healthcare practices in patients sustaining a traumatic brain injury is of major concern given the high incidence of death and long-term disabilities. Considering the brain's susceptibility to ischaemia, strategies to optimise oxygenation to brain are needed. While red blood cell (RBC) transfusion is one such strategy, specific RBC strategies are debated. We aimed to evaluate RBC transfusion frequency, determinants of transfusions and associated clinical outcomes. METHODS We conducted a retrospective multicentre cohort study using data from the National Trauma Registry of Canada. Patients admitted with moderate or severe traumatic brain injury to participating hospitals between April 2005 and March 2013 were eligible. Patient information on blood products, comorbidities, interventions and complications from the Discharge Abstract Database were linked to the National Trauma Registry data. Relative weights analyses evaluated the contribution of each determinant. We conducted multivariate robust Poisson regression to evaluate the association between potential determinants, mortality, complications, hospital-to-home discharge and RBC transfusion. We also used proportional hazard models to evaluate length of stay for time to discharge from ICU and hospital. RESULTS Among the 7062 patients with traumatic brain injury, 1991 patients received at least one RBC transfusion during their hospital stay. Female sex, anaemia, coagulopathy, sepsis, bleeding, hypovolemic shock, other comorbid illnesses, serious extracerebral trauma injuries were all significantly associated with RBC transfusion. Serious extracerebral injuries altogether explained 61% of the observed variation in RBC transfusion. Mortality (risk ratio (RR) 1.23 (95% CI 1.13 to 1.33)), trauma complications (RR 1.38 (95% CI 1.32 to 1.44)) and discharge elsewhere than home (RR 1.88 (95% CI 1.75 to 2.04)) were increased in patients who received RBC transfusion. Discharge from ICU and hospital were also delayed in transfused patients. CONCLUSIONS RBC transfusion is common in patients with traumatic brain injury and associated with unfavourable outcomes. Trauma severity is an important determinant of RBC transfusion. Prospective studies are needed to further evaluate optimal transfusion strategies in traumatic brain injury.
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Affiliation(s)
- Amélie Boutin
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
| | - Lynne Moore
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Université Laval, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Université Laval, Québec, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada
| | - Michaël Chassé
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Université Laval, Québec, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada
| | - Shane English
- Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Critical Care Medicine, of Haematology and of Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Donald Griesdale
- Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Université Laval, Québec, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Québec, Canada
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Boyd JM, Moore L, Atenafu EG, Hamid JS, Nathens A, Stelfox HT. A retrospective cohort study of the relationship between quality indicator measurement and patient outcomes in adult trauma centers in the United States. Injury 2017; 48:13-19. [PMID: 27847191 DOI: 10.1016/j.injury.2016.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/14/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Improving care is a key strategy for reducing the burden of injuries, but it is unknown whether the use of quality indicators (QI) is associated with patient outcomes. We sought to evaluate the association between the use of QIs by trauma centers and outcomes in adult injury patients. METHODS We identified consecutive adult patients (n=223,015) admitted to 233 verified trauma centers January 1, 2007 to December 31, 2010 that contributed data to the National Trauma Data Bank and participated in a survey of QI practices. Generalized Linear Mixed Models were employed to evaluate the association between the intensity (number of QIs) and nature (report cards, internal and external benchmarking) of QI use and survival to hospital discharge, adjusting for patient and hospital characteristics. RESULTS There were no significant differences in the odds of survival to trauma center discharge according to the number of QIs measured (quartiles; odds ratio{OR} [95% confidence interval{CI}] 1.00 vs. 1.08 [0.90-1.31] vs. 1.00 [0.82-1.22] vs. 1.21 [0.99-1.49]), or whether centers used reports cards (OR 1.07, 95%CI 0.94-1.23), internal (OR 1.06, 95%CI 0.89-1.26) or external (OR 1.09, 95%CI 0.92-1.31) benchmarking. The duration (geometric mean) of mechanical ventilation (4.0days), ICU stay (4.6days), hospital stay (7.7days) and proportion of patients with a complication (13.6%) did not significantly differ according to the intensity or nature of QI use. CONCLUSIONS The intensity and nature of the QIs used by trauma centers was not associated with outcomes of patient care. Alternative quality improvement strategies may be needed.
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Affiliation(s)
- Jamie M Boyd
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; W21C Research and Innovation Center, Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
| | - Eshetu G Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| | - Jemila S Hamid
- Li Ka Shing Knowledge Institute, St. Micheal's Hospital, Toronto, Canada; Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - Avery Nathens
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Henry T Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada.
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Araujo GLD, Whitaker IY. Morbidade hospitalar de motociclistas acidentados: fatores associados ao tempo de internação. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar fatores associados ao tempo de internação hospitalar de motociclistas acidentados. Métodos Estudo transversal, retrospectivo sobre motociclistas com lesões traumáticas agudas atendidos e internados em três hospitais referência para trauma de São Paulo. Prontuários de pacientes e laudo de necropsia foram consultados para obter variáveis que poderiam se associar ao tempo de internação, seguida da análise de regressão linear múltipla para verificar fatores associados. Resultados Análise de 91 motociclistas mostrou que o aumento da gravidade do trauma e as complicações infecciosas, úlcera por pressão, rabdomiólise e síndrome da angustia respiratória aguda associaram-se com maior tempo de internação (p<0,05). A úlcera por pressão e a infecção do sitio cirúrgico foram fatores preditores do aumento do tempo de internação e o óbito como preditor de redução da internação. Conclusão Os fatores que se associaram ao tempo de internação resultaram tanto das lesões traumáticas quanto do processo assistencial prestado aos motociclistas acidentados.
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Evolution of Patient Outcomes Over 14 Years in a Mature, Inclusive Canadian Trauma System. World J Surg 2015; 39:1397-405. [DOI: 10.1007/s00268-015-2977-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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