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Sullivan GA, Reddy S, Reiter AJ, Zeineddin S, Visenio M, Hu A, Mackersie R, Kabre R, Raval MV, Stey AM. Does Trauma Center Volume Account for the Association Between Trauma Center Verification Level and In-Hospital Mortality among Children Injured by Firearms in California? J Am Coll Surg 2023; 237:738-749. [PMID: 37581372 PMCID: PMC11410053 DOI: 10.1097/xcs.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Heterogeneity in trauma center designation and injury volume offer possible explanations for inconsistencies in pediatric trauma center designation's association with lower mortality among children. We hypothesized that rigorous trauma center verification, regardless of volume, would be associated with lower firearm injury-associated mortality in children. STUDY DESIGN This retrospective cohort study leveraged the California Office of Statewide Health Planning and Development patient discharge data. Data from children aged 0 to 14 years in California from 2005 to 2018 directly transported with firearm injuries were analyzed. American College of Surgeons (ACS) trauma center verification level was the primary predictor of in-hospital mortality. Centers' annual firearm injury volume data were analyzed as a mediator of the association between center verification level and in-hospital mortality. Two mixed-effects multivariable logistic regressions modeled in-hospital mortality and the estimated association with center verification while adjusting for patient demographic and clinical characteristics. One model included the center's firearm injury volume and one did not. RESULTS The cohort included 2,409 children with a mortality rate of 8.6% (n = 206). Adjusted odds of mortality were lower for children at adult level I (adjusted odds ratio [aOR] 0.38, 95% CI 0.19 to 0.80), pediatric (aOR 0.17, 95% CI 0.05 to 0.61), and dual (aOR 0.48, 95% CI 0.25 to 0.93) trauma centers compared to nontrauma/level III/IV centers. Firearm injury volume did not mediate the association between ACS trauma center verification and mortality (aOR/10 patient increase in volume 1.01, 95% CI 0.99 to 1.03). CONCLUSIONS Trauma center verification level, regardless of firearm injury volume, was associated with lower firearm injury-associated mortality, suggesting that the ACS verification process is contributing to achieving optimal outcomes.
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Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL (Sullivan, Reiter, Zeineddin, Hu, Kabre, Raval)
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL (Sullivan)
| | - Susheel Reddy
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (Reddy, Visenio, Stey)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL (Sullivan, Reiter, Zeineddin, Hu, Kabre, Raval)
| | - Suhail Zeineddin
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL (Sullivan, Reiter, Zeineddin, Hu, Kabre, Raval)
| | - Michael Visenio
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (Reddy, Visenio, Stey)
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL (Sullivan, Reiter, Zeineddin, Hu, Kabre, Raval)
| | - Robert Mackersie
- Department of Surgery, University of California San Francisco, San Francisco, CA (Mackersie)
| | - Rashmi Kabre
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL (Sullivan, Reiter, Zeineddin, Hu, Kabre, Raval)
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL (Sullivan, Reiter, Zeineddin, Hu, Kabre, Raval)
| | - Anne M Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (Reddy, Visenio, Stey)
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Foppen W, Claassen Y, Falck D, van der Meer NJM. Trauma Patient Volume and the Quality of Care: A Scoping Review. J Clin Med 2023; 12:5317. [PMID: 37629358 PMCID: PMC10455163 DOI: 10.3390/jcm12165317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Healthcare stakeholders in the Netherlands came to an agreement in 2022 to deal with present and future challenges in healthcare. Among others, this agreement contains clear statements regarding the concentration of trauma patients, including the minimal required number of annual severe trauma patients for Major Trauma Centers. This review investigates the effects of trauma patient volumes on several domains of the quality of healthcare. METHODS PubMed was searched; studies published during the last 10 years reporting quantitative data on trauma patient volume and quality of healthcare were included. Results were summarized and categorized into the quality domains of healthcare. RESULTS Seventeen studies were included with a total of 1,517,848 patients. A positive association between trauma patient volume and survival was observed in 11/13 studies with adjusted analyses. Few studies addressed other quality domains: efficiency (n = 5), safety (n = 2), and time aspects of care (n = 4). None covered people-centeredness, equitability, or integrated care. CONCLUSIONS Most studies showed a better survival of trauma patients when treated in high-volume hospitals compared to lower volume hospitals. However, the ideal threshold could not be determined. The association between trauma volume and other domains of the quality of healthcare remains unclear.
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Affiliation(s)
- Wouter Foppen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Yvette Claassen
- Department of Surgery, Leids Universitair Medisch Centrum, 2333 ZA Leiden, The Netherlands
| | - Debby Falck
- Department of Neurology, HagaZiekenhuis, 2545 AA The Hague, The Netherlands
| | - Nardo J. M. van der Meer
- Department of Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
- TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
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Maughan KS, Romain M, Brown DB. Use of Ethylene Vinyl Copolymer for Embolization Outside the Central Nervous System: A Case Review. Semin Intervent Radiol 2023; 40:221-230. [PMID: 37333750 PMCID: PMC10275679 DOI: 10.1055/s-0043-1768611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- Kyle S. Maughan
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mike Romain
- Meharry Medical College, Nashville, Tennessee
| | - Daniel B. Brown
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Toida C, Muguruma T, Gakumazawa M, Shinohara M, Abe T, Takeuchi I. Ten-year in-hospital mortality trends among Japanese injured patients by age, injury severity, injury mechanism, and injury region: A nationwide observational study. PLoS One 2022; 17:e0272573. [PMID: 35994453 PMCID: PMC9394834 DOI: 10.1371/journal.pone.0272573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
The Injury Severity Score (ISS) is widely used in trauma research worldwide. An ISS cutoff value of ≥16 is frequently used as the definition of severe injury in Japan. The mortality of patients with ISS ≥16 has decreased in recent years, owing to the developing the trauma care system. This study aimed to analyze the prevalence, in-hospital mortality, and odds ratio (OR) for mortality in Japanese injured patients by age, injury mechanism, injury region, and injury severity over 10 years. This study used the Japan Trauma Data Bank (JTDB) dataset, which included 315,614 patients registered between 2009 and 2018. 209,290 injured patients were utilized. This study evaluated 10-year trends of the prevalence and in-hospital mortality and risk factors associated with in-hospital mortality. The overall in-hospital mortality was 10.5%. During the 10-year study period in Japan, the mortality trend among all injured patient groups with ISS 0–15, 16–25, and ≥26 showed significant decreases (p <0.001). Moreover, the mortality risk of patients with ISS ≥26 was significantly higher than that of patients with ISS 0–15 and 16–25 (p <0.001, OR = 0.05 and p<0.001, OR = 0.22). If we define injured patients who are expected to have a mortality rate of 20% or more as severely injured, it may be necessary to change the injury severity definition according to reduction of trauma mortality as ISS cutoff values to ≥26 instead of ≥16. From 2009 to 2018, the in-hospital mortality trend among all injured patient groups with ISS 0–15, 16–25, and ≥26 showed significant decreases in Japan. Differences were noted in mortality trends and risks according to anatomical injury severity.
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Affiliation(s)
- Chiaki Toida
- Department of Disaster Medical Management, The University of Tokyo, Tokyo, Japan
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail:
| | - Takashi Muguruma
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masayasu Gakumazawa
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mafumi Shinohara
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Kishawi SK, Tseng ES, Adomshick VJ, Towe CW, Ho VP. Race and trauma mortality: The effect of hospital-level Black-White patient race distribution. J Trauma Acute Care Surg 2022; 92:958-966. [PMID: 35125445 PMCID: PMC9133009 DOI: 10.1097/ta.0000000000003538] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Race-related health disparities have been well documented in the United States. In some settings, Black patients have better outcomes in hospitals that serve high proportions of Black patients. We hypothesized that Black trauma patients would have lower mortality in high Black-serving (H-BS) hospitals. METHODS We identified all adult patients with Black or White race and with an Injury Severity Score of ≥4 from the 2017 National Inpatient Sample. We collected hospital identifier, mechanism, age, sex, comorbidities, urban-rural location, insurance, zip code income quartile, and injury severity calculated from International Classification of Diseases, Tenth Revision, codes. We used a previously published method to group hospitals by proportion of Black patients served: HB-S (top 5%), medium Black serving (5-25%), and low Black serving (L-BS; bottom 75%). Adjusted logistic regression using an interaction variable between race and hospital service rank (reference: White patients in H-BS) was used to identify factors associated with mortality. RESULTS We analyzed 184,080 trauma patients (median age, 72 years [interquartile range, 55-84 years]; Injury Severity Score, 9 [4-10]), of whom 11.7% were Black. Overall mortality was 4%. Of 2,376 hospitals, 126 (5.3%) were H-BS and 469 (19.7%) were medium Black serving. Furthermore, 29.8% of Black and 3.6% of White patients were treated at H-BS hospitals, while 71.7% of White and 23.6% of Black patients were treated at L-BS hospitals (p < 0.001). Black patients had the lowest mortality at H-BS hospitals (odds ratio [OR], 0.76 [0.64-0.92]) and the highest mortality (OR, 1.43 [1.13-1.80]) at L-BS hospitals. White patients had the lowest mortality at L-BS hospitals (OR, 0.76 [0.64-0.92]). CONCLUSION After adjusting for patient and hospital factors, disparities exist such that Black and White patients have the best outcomes in hospitals that treat those patients most frequently, suggesting potential for racial bias at the institutional level. Further efforts must be made to promote equitable treatment at all hospitals and reduce these disparities. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
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Affiliation(s)
- Sami K. Kishawi
- MetroHealth Medical Center, Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, 2500 MetroHealth Drive, Cleveland, OH 44109
- University Hospitals Cleveland Medical Center, Department of Surgery, 11100 Euclid Avenue, Lakeside 7 Floor, Cleveland, OH 44106
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106
| | - Esther S. Tseng
- MetroHealth Medical Center, Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, 2500 MetroHealth Drive, Cleveland, OH 44109
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106
| | - Victoria J. Adomshick
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106
| | - Christopher W. Towe
- University Hospitals Cleveland Medical Center, Department of Surgery, 11100 Euclid Avenue, Lakeside 7 Floor, Cleveland, OH 44106
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106
| | - Vanessa P. Ho
- MetroHealth Medical Center, Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, 2500 MetroHealth Drive, Cleveland, OH 44109
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106
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After 9,000 Laparotomies for Blunt Trauma, Resuscitation Is Becoming More Balanced and Time to Intervention Shorter: Evidence in Action. J Trauma Acute Care Surg 2022; 93:307-315. [PMID: 35343923 DOI: 10.1097/ta.0000000000003574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study is to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy. METHODS This is a 5-year (2013-2017) analysis of the Trauma Quality Improvement Program. Adult (age ≥ 18 years) blunt trauma patients with early (≤4 hours) PRBC and FFP transfusions and an emergency (≤4 hours) laparotomy for hemorrhage control were identified. Time-trend analysis of 24-hour mortality, PRBC/FFP ratio, and time to laparotomy was performed over the study period. The association between mortality and PRBC/FFP ratio, patient demographics, injury characteristics, transfusion volumes, and ACS verification level was examined by hierarchical regression analysis adjusting for inter-year variability. RESULTS A total of 9,773 blunt trauma patients with emergency laparotomy were identified. Mean age was 44 ± 18 years, 67.5% were male, and median ISS was 34 [24-43]. Mean SBP at presentation was 73 ± 28 mm Hg, and median transfusion requirements were PRBC 9 [5-17] and FFP 6 [3-12]. During the 5-year analysis, time to laparotomy decreased from 1.87 hours to 1.37 hours (p < 0.001), PRBC/FFP ratio at 4 hours decreased from 1.93 to 1.71 (p < 0.001), and 24-hour mortality decreased from 23.0% to 19.3% (p = 0.014). (Figure) On multivariate analysis, decreased PRBC/FFP ratio was independently associated with decreased 24-hour mortality (OR 0.88; p < 0.001) and in-hospital mortality (OR 0.89; p < 0.001). CONCLUSION Resuscitation is becoming more balanced and time to emergency laparotomy shorter in blunt trauma patients, with a significant improvement in mortality. Future efforts should be directed towards incorporating transfusion practices and timely surgical interventions as markers of trauma center quality. LEVEL OF EVIDENCE Level III.
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Descamps C, Hamada S, Hanouz JL, Vardon-Bounes F, James A, Garrigue D, Abback P, Cardinale M, Dubreuil G, Chatelon J, Cook F, Neuschwander A, de Garambé N, Ausset S, Boutonnet M. Gunshot and stab wounds in France: descriptive study from a national trauma registry. Eur J Trauma Emerg Surg 2021; 48:3821-3829. [PMID: 34232339 DOI: 10.1007/s00068-021-01742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Severe trauma is a major problem worldwide. In France, blunt trauma (BT) is predominant and few studies are available on penetrating trauma (PT). The purpose of this study was to perform a descriptive analysis of severe gunshot (GSW) and stab wounds (SW) in patients who were treated in French trauma centers. METHODS Retrospective study on prospectively collected data in a national trauma registry. All adult (> 15 years) trauma patients primarily admitted in 1 of the 17 trauma centers members of the Traumabase between January 2015 to December 2018 were included. Data from patients who had a PT were compared with those who had suffered a BT over the same period. Due to the known differences between GSW and SW, sub-group analyses on data from GSW, SW and BT were also performed. RESULTS 8128 patients were included. Twelve percent of the study group had a PT. The main mechanism of PT was SW (68.1%). Five hundred and eighty patients with PT (59.4%) required surgery within the first 24 h. Severe hemorrhage was more frequent in penetrating traumas (11.2% vs. 7.8% p < 0.001). Hospital mortality following PT was 8.9% vs 11% for blunt trauma (p = 0.047). Among PT the mortality after GSW was ten times higher than after SW (23.8% vs 2%). CONCLUSION This work is the largest study to date that has specifically focused on GSW and SW in France, and will help improving knowledge in managing such patients in our country.
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Affiliation(s)
- Chloé Descamps
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Sophie Hamada
- Department of Anaesthesiology and Critical Care, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, 25, rue Leblanc, 75015, Paris, France.,CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Maison de Solenn, 97, boulevard de Port-Royal, 75014, Paris, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Intensive Care Medicine, Caen University Hospital, and Normandie Univ, UNICAEN, Caen, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | - Arthur James
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, 75013, Paris, France
| | - Delphine Garrigue
- Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Paer Abback
- Department of Anaesthesiology and Intensive Care, DMU PARABOL, AP-HP.Nord, Beaujon Hospital, University of Paris, Clichy, France
| | - Mickaël Cardinale
- Anesthesiology and Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Guillaume Dubreuil
- Department of Anesthesia and Critical Care, AP-HP, Bicêtre Hospital, Paris, France
| | - Jeanne Chatelon
- Anesthesiology and Intensive Care Unit. Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Fabrice Cook
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris-Est Créteil University, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Arthur Neuschwander
- Department of Anaesthesiology and Critical Care, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, 25, rue Leblanc, 75015, Paris, France
| | - Nathalie de Garambé
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Sylvain Ausset
- French Military Health Service Schools, Lyon-Bron, France
| | - Mathieu Boutonnet
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France. .,Val-de-Grâce Military Health Academy, Paris, France.
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Giummarra MJ, Dipnall JF, Gibson G, Beck B, Gabbe BJ. Health status after penetrating major trauma in Victoria, Australia: a registry-based cohort study. Qual Life Res 2021; 30:3511-3521. [PMID: 34032955 DOI: 10.1007/s11136-021-02876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE As few studies have examined long-term health after penetrating injury, this population-based registry study sought to assess health outcomes up to 24 months post-injury. METHODS Major trauma patients with penetrating trauma (2009-2017) were included from the Victorian State Trauma Registry (N = 1,067; 102 died, 208 were lost to follow-up). The EQ-5D-3L was used to measure health status at 6, 12 and 24-months. Mixed linear and logistic regressions were used to examine predictors of summary scores, and problems versus no problems on each health dimension. RESULTS Average health status summary scores were 0.70 (sd = 0.26) at 6 and 12 months, and 0.72 (sd = 0.26) at 24 months post-injury. Prevalence of problems was consistent over time: mobility (24-26%), self-care (17-20%), usual activities (47-50%), pain/discomfort (44-49%), and anxiety/depression (54-56%). Lower health status and reporting problems was associated with middle-older age, female sex, unemployment; pre-injury disability, comorbid conditions; and assault and firearm injury versus cutting/piercing. CONCLUSION Problems with usual activities, pain/discomfort and anxiety or depression are common after penetrating major trauma. Risk factor screening in hospital could be used to identify people at risk of poor health outcomes, and to link people at risk with services in hospital or early post-discharge to improve their longer-term health outcomes.
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Affiliation(s)
- Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
| | - Joanna F Dipnall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine , Deakin University, Geelong, VIC, Australia
| | - Georgia Gibson
- Institute for Social Neuroscience, Ivanhoe, VIC, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, UK, SA2 8PP, Wales
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Correlation between Hospital Volume of Severely Injured Patients and In-Hospital Mortality of Severely Injured Pediatric Patients in Japan: A Nationwide 5-Year Retrospective Study. J Clin Med 2021; 10:jcm10071422. [PMID: 33915985 PMCID: PMC8037962 DOI: 10.3390/jcm10071422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital (p < 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital (p < 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality (p = 0.246, 2.13 (0–8.33) vs. 0 (0–100)) and standardized mortality ratio (SMR) values (p = 0.244, 0.31 (0–0.79) vs. 0 (0–4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP.
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Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study. J Clin Med 2020; 9:jcm9103273. [PMID: 33053890 PMCID: PMC7600450 DOI: 10.3390/jcm9103273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.
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Durso AM, Paes FM, Caban K, Danton G, Braga TA, Sanchez A, Munera F. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol 2020; 130:109187. [DOI: 10.1016/j.ejrad.2020.109187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
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Zeindler M, Amsler F, Gross T. Comparative analysis of MGAP, GAP, and RISC2 as predictors of patient outcome and emergency interventional need in emergency room treatment of the injured. Eur J Trauma Emerg Surg 2020; 47:2017-2027. [PMID: 32285143 DOI: 10.1007/s00068-020-01361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Little is known about the capabilities of triage and risk scores to predict the outcomes of injured patients, other than mortality, or to determine the need for trauma center resources. METHODS Retrospective analysis of prospectively gathered monocenter data on consecutively admitted adult emergency room trauma patients. For each patient, the GAP (Glasgow Coma Scale, Age and Pressure), MGAP (mechanism + GAP) scores and the revised injury severity classification 2 (RISC2) were calculated. The predictive performance of these scores was compared for the assessment of trauma severity, hospital resource need and early patient outcomes (area under the receiver operator characteristics, AUROC). RESULTS 2112 patients were evaluated [mean age 49.1 years; Injury Severity Score (ISS) 9.5]. GAP, MGAP, and RISC2 worked best at predicting mortality (AUROC 93.2, 93.5 and 96.1%, respectively). Other endpoints such as ISS > 15, emergency interventions, disability status, and return-not-home were predicted less precisely by these three scores, better by RISC2 (AUROC range 66.2-88.8%) than by (M)GAP-scores (55.2-84.1%), except for preclinical interventions. Over- and undertriage rates for the (M)GAP scores varied between 27.5-53.4% and 10.4-30%, respectively. CONCLUSION The almost comparable precision of the three risk scores in the prediction of outcome or interventional need following trauma, and the fact, that the RISC2 can only be calculated following extensive diagnostics, favor earlier applicable (M)GAP scoring in the emergency setting. Overall, due to its easier use, the GAP appears to be the most preferable for the early assessment and triage of the injured in a trauma setting based on this European trauma center experience (NCT02165137).
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Affiliation(s)
- Michael Zeindler
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Felix Amsler
- Amsler Consulting, Gundeldingerrain 111, 4059, Basel, Switzerland
| | - Thomas Gross
- Department of Traumatology, Cantonal Hospital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
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Yamamoto R, Kurihara T, Sasaki J. A novel scoring system to predict the requirement for surgical intervention in victims of motor vehicle crashes: Development and validation using independent cohorts. PLoS One 2019; 14:e0226282. [PMID: 31821375 PMCID: PMC6903719 DOI: 10.1371/journal.pone.0226282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background Given that there are still considerable number of facilities which lack surgical specialists round the clock across the world, the ability to estimate the requirement for emergency surgery in victims of motor vehicle crashes (MVCs) can ensure appropriate resource allocation. In this study, a surgical intervention in victims of MVC (SIM) score was developed and validated, using independent patient cohorts. Methods We retrospectively identified MVC victims in a nationwide trauma registry (2004–2016). Adults ≥ 15 years who presented with palpable pulse were included. Patients with missing data on the type/date of surgery were excluded. Patient were allocated to development or validation cohorts based on the date of injury. After missing values were imputed, predictors of the need for emergency thoracotomy and/or laparotomy were identified with multivariate logistic regression, and scores were then assigned using odds ratios. The SIM score was validated with area under the receiver operating characteristic curve (AUROC) and calibration plots of SIM score-derived probability and observed rates of emergency surgery. Results We assigned 13,328 and 12,348 patients to the development and validation cohorts, respectively. Age, motor vehicle collision and vital signs on hospital arrival were identified as independent predictors for emergency thoracotomy and/or laparotomy, and SIM score was developed as 0–9 scales. The score has a good discriminatory power (AUROC = 0.79; 95% confidence interval = 0.77–0.81), and both estimated and observed rates of emergency surgery increased stepwise from 1% at a score ≤ 1 to almost 40% at a score ≥ 8 with linear calibration plots. Conclusions The SIM score was developed and validated to accurately estimate the need for emergent thoracotomy and/or laparotomy in MVC victims.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
- * E-mail:
| | - Tomohiro Kurihara
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Kuo LW, Fu CY, Liao CA, Liao CH, Hsieh CH, Wang SY, Chen SW, Cheng CT. Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database. BMJ Open 2019; 9:e032062. [PMID: 31722950 PMCID: PMC6858192 DOI: 10.1136/bmjopen-2019-032062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES: To assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan. DESIGN: A nationwide, retrospective cohort study. SETTING: An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI. PARTICIPANTS: Patients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables. RESULTS: In univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001). CONCLUSION: Even with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.
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Affiliation(s)
- Ling-Wei Kuo
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chien-An Liao
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Trauma and Critical Care Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
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