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Weykamp MB, Liu Z, Fernandez LR, Tuott E, Robinson BRH, Vavilala MS, Stansbury LG, Hess JR. Massive transfusion protocol reactivation as a novel marker of physician team under-triage after injury. Transfusion 2024; 64:248-254. [PMID: 38258481 DOI: 10.1111/trf.17719] [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: 06/24/2023] [Revised: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Large trauma centers have protocols for the assessment of injury and triaging of care with attempts to over-triage to ensure adequate care for all patients. We noted that a significant number of patients undergo a second massive transfusion protocol (MTP) activation in the first 24 h of care and conducted a retrospective cohort study of patients involved over a 3-year period. METHODS Transfusion service records of MTP activations 2019-2021 were linked to Trauma Registry records and divided into cohorts receiving a single versus a reactivation of the MTP. Time of activation and amounts of blood products issued were linked to demographic, injury severity, and outcome data. Categorical and continuous data were compared between cohorts with chi-squared, Fisher's, and Wilcoxan tests as appropriate, and multivariable regression models were used to seek interactions (p < .05). RESULTS MTP activation was recorded for 1884 acute trauma patients over our 3-year study period, 142 of whom (7.5%) had reactivation. Factors associated with reactivation included older age (46 vs. 40 years), higher injury severity score (ISS, 27 vs. 22), leg injuries, and presentation during morning shift change (5-7 a.m., 3.3% vs. 7.7%). Patients undergoing MTP reactivation used more RBCs (5 U vs. 2 U) and had more ICU days (3 vs. 2). CONCLUSIONS Older patients and those presenting during shift change are at risk for failure to recognize their complex injury patterns and under-triage for trauma care. The fidelity and granularity of transfusion service records can provide unique opportunities for quality assessment and improvement in trauma care.
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Affiliation(s)
- Michael B Weykamp
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Zhinan Liu
- Transfusion Service, Harborview Medical Center, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Lauren R Fernandez
- Transfusion Service, Harborview Medical Center, Seattle, Washington, USA
| | - Erin Tuott
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Bryce R H Robinson
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Transfusion Service, Harborview Medical Center, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Lupton JR, Davis‐O'Reilly C, Jungbauer RM, Newgard CD, Fallat ME, Brown JB, Mann NC, Jurkovich GJ, Bulger E, Gestring ML, Lerner EB, Chou R, Totten AM. Mechanism of injury and special considerations as predictive of serious injury: A systematic review. Acad Emerg Med 2022; 29:1106-1117. [PMID: 35319149 PMCID: PMC9545392 DOI: 10.1111/acem.14489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Centers for Disease Control and Prevention's field triage guidelines (FTG) are routinely used by emergency medical services personnel for triaging injured patients. The most recent (2011) FTG contains physiologic, anatomic, mechanism, and special consideration steps. Our objective was to systematically review the criteria in the mechanism and special consideration steps that might be predictive of serious injury or need for a trauma center. METHODS We conducted a systematic review of the predictive utility of mechanism and special consideration criteria for predicting serious injury. A research librarian searched in Ovid Medline, EMBASE, and the Cochrane databases for studies published between January 2011 and February 2021. Eligible studies were identified using a priori inclusion and exclusion criteria. Studies were excluded if they lacked an outcome for serious injury, such as measures of resource use, injury severity scores, mortality, or composite measures using a combination of outcomes. Given the heterogeneity in populations, measures, and outcomes, results were synthesized qualitatively focusing on positive likelihood ratios (LR+) whenever these could be calculated from presented data or adjusted odds ratios (aOR). RESULTS We reviewed 2418 abstracts and 315 full-text publications and identified 42 relevant studies. The factors most predictive of serious injury across multiple studies were death in the same vehicle (LR+ 2.2-7.4), ejection (aOR 3.2-266.2), extrication (LR+ 1.1-6.6), lack of seat belt use (aOR 4.4-11.3), high speeds (aOR 2.0-2.9), concerning crash variables identified by vehicle telemetry systems (LR+ 4.7-22.2), falls from height (LR+ 2.4-5.9), and axial load or diving (aOR 2.5-17.6). Minor or inconsistent predictors of serious injury were vehicle intrusion (LR+ 0.8-7.2), cardiopulmonary or neurologic comorbidities (LR+ 0.8-3.1), older age (LR+ 0.6-6.8), or anticoagulant use (LR+ 1.1-1.8). CONCLUSIONS Select mechanism and special consideration criteria contribute positively to appropriate field triage of potentially injured patients.
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Affiliation(s)
- Joshua R. Lupton
- Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Cynthia Davis‐O'Reilly
- Pacific Northwest Evidence‐based Practice Center, Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregonUSA
| | - Rebecca M. Jungbauer
- Pacific Northwest Evidence‐based Practice Center, Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregonUSA
| | - Craig D. Newgard
- Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Mary E. Fallat
- Department of SurgeryUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | - Joshua B. Brown
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - N. Clay Mann
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | | | - Eileen Bulger
- Department of SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Mark L. Gestring
- Department of SurgeryUniversity of RochesterRochesterNew YorkUSA
| | - E. Brooke Lerner
- Department of Emergency MedicineUniversity at BuffaloBuffaloNew YorkUSA
| | - Roger Chou
- Pacific Northwest Evidence‐based Practice Center, Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregonUSA
| | - Annette M. Totten
- Pacific Northwest Evidence‐based Practice Center, Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregonUSA
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3
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Newgard CD, Fischer PE, Gestring M, Michaels HN, Jurkovich GJ, Lerner EB, Fallat ME, Delbridge TR, Brown JB, Bulger EM. National guideline for the field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2021. J Trauma Acute Care Surg 2022; 93:e49-e60. [PMID: 35475939 PMCID: PMC9323557 DOI: 10.1097/ta.0000000000003627] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
This work details the process of developing the updated field triage guideline, the supporting evidence, and the final version of the 2021 National Guideline for the Field Triage of Injured Patients.
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Affiliation(s)
- Craig D. Newgard
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Peter E. Fischer
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Mark Gestring
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Holly N. Michaels
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Gregory J. Jurkovich
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - E. Brooke Lerner
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Mary E. Fallat
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Theodore R. Delbridge
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Joshua B. Brown
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - Eileen M. Bulger
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
| | - the Writing Group for the 2021 National Expert Panel on Field Triage
- From the Department of Emergency Medicine (C.D.N., J.R.L.), Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (M.G.), University of Rochester, Rochester, New York; Committee on Trauma (H.N.M., M.N., M.D., J.D.), American College of Surgeons, Chicago, Illinois; Department of Surgery (G.J.J.), UC Davis Health, Sacramento, California; Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York; Department of Surgery (M.E.F.), University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky; Maryland Institute for Emergency Medical Services Systems (T.R.D.), Baltimore, Maryland; Division of Trauma and General Surgery, Department of Surgery (J.B.B.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
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4
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Kang BH, Jung K, Kim S, Youn SH, Song SY, Huh Y, Chang HJ. Accuracy and influencing factors of the Field Triage Decision Scheme for adult trauma patients at a level-1 trauma center in Korea. BMC Emerg Med 2022; 22:101. [PMID: 35672707 PMCID: PMC9172086 DOI: 10.1186/s12873-022-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the accuracy of the prehospital Field Triage Decision Scheme, which has recently been applied in the Korean trauma system, and the factors associated with severe injury and prognosis at a regional trauma center in Korea. METHODS From 2016 to 2018, prehospital data of injured patients were obtained from the emergency medical services of the national fire agency and matched with trauma outcomes at our institution. Severe injury (Injury Severity Score > 15), overtriage/undertriage rate, positive predictive value, negative predictive value, and accuracy were reviewed according to the triage protocol steps. A multivariate logistic regression analysis was performed to identify influencing factors in the field triage. RESULTS Of the 2438 patients reviewed, 853 (35.0%) were severely injured. The protocol accuracy was as follows: step 1, 72.3%; step 2, 65.0%; step 3, 66.2%; step 1 or 2, 70.2%; and step 1, 2, or 3, 66.4%. Odds ratios (OR) (95% confidence interval [CIfor systolic blood pressure < 90 mmHg (3.535 [1.920-6.509]; p < 0.001), altered mental status (17.924 [8.980-35.777]; p < 0.001), and pedestrian injuries (2.473 [1.339-4.570], p = 0.04) were significantly associated with 24-h mortality. Penetrating torso injuries (7.108 [4.108-12.300]; p < 0.001); two or more proximal long bone fractures (4.134 [2.316-7.377]); p < 0.001); crushed, degloved, and mangled extremities (8.477 [4.068-17.663]; p < 0.001); amputation proximal to the wrist or ankle (42.964 [5.764-320.278]; p < 0.001); and fall from height (2.141 [1.497-3.062]; p < 0.001) were associated with 24-h surgical intervention. CONCLUSION The Korean field triage protocol is not yet accurate, with only some factors reflecting injury severity, making reevaluation necessary.
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Affiliation(s)
- Byung Hee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Korea.,Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Korea.,Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - Sora Kim
- Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - So Hyun Youn
- Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - Seo Young Song
- Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Korea. .,Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea.
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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Jouffroy R, Brami E, Scannavino M, Daniel Y, Bertho K, Abriat A, Salomé M, Lemoine S, Jost D, Prunet B, Travers S. Association between prehospital shock index and mortality among patients with COVID-19 disease. Am J Emerg Med 2022; 56:133-136. [PMID: 35397353 PMCID: PMC8970620 DOI: 10.1016/j.ajem.2022.03.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022] Open
Abstract
Background There exists a need for prognostic tools for the early identification of COVID-19 patients requiring intensive care unit (ICU) admission and mortality. Here we investigated the association between a clinical (initial prehospital shock index (SI)) and biological (initial prehospital lactatemia) tool and the ICU admission and 30-day mortality among COVID-19 patients cared for in the prehospital setting. Methods We retrospectively analysed COVID-19 patients initially cared for by a Paris Fire Brigade advanced (ALS) or basic life support (BLS) team in the prehospital setting between 2020, March 08th and 2020, May 30th. We assessed the association between prehospital SI and prehospital lactatemia and ICU admission and mortality using logistic regression model analysis after propensity score matching with Inverse Probability Treatment Weighting (IPTW) method. Covariates included in the IPTW propensity analysis were: age, sex, body mass index (BMI), initial respiratory rate (iRR), initial pulse oximetry without (SpO2i) and with oxygen supplementation (SpO2i.O2), initial Glasgow coma scale (GCSi) value, initial prehospital SI and initial prehospital lactatemia. Results We analysed 410 consecutive COVID-19 patients [254 males (62%); mean age, 64 ± 18 years]. Fifty-seven patients (14%) deceased on the scene, of whom 41 (72%) were male and were significantly older (71 ± 12 years vs. 64 ± 19 years; P 〈10−3). Fifty-three patients (15%) were admitted in ICU and 39 patients (11%) were deceased on day-30. The mean prehospital SI value was 1.5 ± 0.4 and the mean prehospital lactatemia was 2.0 ± 1.7 mmol.l−1. Multivariate logistic regression analysis on matched population after IPTW propensity analysis reported a significant association between ICU admission and age (adjusted Odd-Ratio (aOR), 0.90; 95% confidence interval (95%CI): 0.93–0.98;p = 10−3), SpO2i.O2 (aOR, 1.10; 95%CI: 1.02–1.20;p = 0.002) and BMI (aOR, 1.09; 95% CI: 1.03–1.16;p = 0.02). 30-day mortality was significantly associated with SpO2i.O2 (aOR, 0.92; 95% CI: 0.87–0.98;p = 0.01 P < 10−3) and GCSi (aOR, 0.90; 95% CI: 0.82–0.99;p = 0.04). Neither prehospital SI nor prehospital lactatemia were associated with ICU admission and 30-day mortality. Conclusion Neither prehospital initial SI nor lactatemia were associated with ICU admission and 30-day mortality among COVID-19 patients initially cared for by a Paris Fire Brigade BLS or ALS team. Further prospective studies are needed to confirm these preliminary results.
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Affiliation(s)
- Romain Jouffroy
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France.
| | - Elise Brami
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Marine Scannavino
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Yann Daniel
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Kilian Bertho
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Amandine Abriat
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Marina Salomé
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Sabine Lemoine
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Daniel Jost
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
| | - Stéphane Travers
- Paris Fire Brigade, Emergency Medicine dpt, 1 place Jules Renard, 75017 Paris, France
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6
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Giugni A, Gamberini L, Carrara G, Antiga L, Brissy O, Buldini V, Calamai I, Csomos A, De Luca A, Ferri E, Fleming JM, Gradisek P, Kaps R, Kyprianou T, Lagomarsino S, Lazar I, Martino C, Mikaszewska-Sokolewicz M, Montis A, Nardai G, Nattino G, Nattino G, Paci G, Portolani L, Xirouchaki N, Chieregato A, Bertolini G. Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury. Scand J Trauma Resusc Emerg Med 2021; 29:158. [PMID: 34727955 PMCID: PMC8561979 DOI: 10.1186/s13049-021-00959-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/22/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). METHODS The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. RESULTS A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. CONCLUSIONS In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.
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Affiliation(s)
- Aimone Giugni
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Lorenzo Gamberini
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Greta Carrara
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy
| | | | - Obou Brissy
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy
| | - Virginia Buldini
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Italo Calamai
- Anesthesia and Intensive Care Unit, AUSL Toscana Centro, San Giuseppe Hospital, Empoli, Florence, Italy
| | - Akos Csomos
- Hungarian Army Medical Center, Budapest, Hungary
| | - Alessandra De Luca
- Neurointensive Care Unit, Department of Anesthesia and Intensive Care Unit, AOU Careggi, Florence, Italy
| | - Enrico Ferri
- Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | - Joanne M Fleming
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rafael Kaps
- General Hospital Novo Mesto, Novo Mesto, Slovenia
| | - Theodoros Kyprianou
- University of Nicosia Medical School, Nicosia, Cyprus
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Silvia Lagomarsino
- Neurointensive Care Unit, Department of Anesthesia and Intensive Care Unit, AOU Careggi, Florence, Italy
| | - Isaac Lazar
- Pediatric Intensive Care Unit, Soroka Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Costanza Martino
- Anesthesia and Intensive Care Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | | | - Andrea Montis
- Department of Neurorehabilitation, ASSL Oristano, ATS Sardegna, Oristano, Italy
| | - Gabor Nardai
- Department of Anaesthesiology and Intensive Care, Péterfy Hospital and Trauma Centre, Budapest, Hungary
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy.
| | - Giuseppe Nattino
- Intensive Care Unit, Azienda Socio Sanitaria Territoriale di Lecco, Lecco, Italy
| | - Giulia Paci
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy
| | - Laila Portolani
- Anesthesia and Intensive Care Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | | | - Arturo Chieregato
- Neurointensive Care Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy
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Wu CA, Dutta R, Virk S, Roy N, Ranganathan K. The need for craniofacial trauma and oncologic reconstruction in global surgery. J Oral Biol Craniofac Res 2021; 11:563-567. [PMID: 34430193 DOI: 10.1016/j.jobcr.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022] Open
Abstract
The global burden of surgical disease is concentrated in low- and middle-income countries and primarily consists of injuries and malignancies. While global reconstructive surgery has a long and well-established history, efforts thus far have been focused on addressing congenital anomalies. Craniofacial trauma and oncologic reconstruction are comparatively neglected despite their higher prevalence. This review explores the burden, management, and treatment gaps of craniofacial trauma and head and neck cancer reconstruction in low-resource settings. We also highlight successful alternative treatments used in low-resource settings and pearls that can be learned from these areas.
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Affiliation(s)
| | - Rohini Dutta
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India.,Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Sargun Virk
- Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India
| | - Kavitha Ranganathan
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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The prehospital SIGARC score to assess septic shock in-hospital, 30-day and 90-day mortality. Am J Emerg Med 2020; 46:355-360. [PMID: 34348435 DOI: 10.1016/j.ajem.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the pre-hospital setting the early identification of septic shock (SS) patients presenting with a high risk of poor outcome remains a daily challenge. The development of a simple score to quickly identify these patients is essential to optimize triage towards the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the new SIGARC score and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). METHODS SS patients cared for by a MICU between 2017, April 15th, and 2019, December 1st were included in this retrospective study. The SIGARC score consists of the addition of 5 following items (1 point for each one): shock index≥1, Glasgow coma scale<13, age > 65, respiratory rate > 22 and comorbidity defined by the presence of at least 2 underlying conditions among: hypertension, coronaropathy, chronic cardiac failure, chronic renal failure, chronic obstructive pulmonary disease, diabetes mellitus, history of cancer and human immunodeficiency virus infection. A threshold of SIGARC score ≥ 2 was arbitrarily chosen to define severity for its usefulness in clinical practice. RESULTS Data from 406 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 71 ± 15 years and 268 of the patients (66%) were male. The presumed origin of SS was pulmonary (42%), digestive (25%) or urinary (17%) infection. Overall in-hospital mortality was 31% with, 30 and 90-day mortality was respectively 28% and 33%. A prehospital SIGARC score ≥ 2 is associated with an increase in 30 and 90-day mortality with HR = 1.57 [1.02-2.42] and 1.82 [1.21-2.72], respectively. CONCLUSION A SIGARC score ≥ 2 is associated with an increase in in-hospital, 30 and 90-day mortality of SS patients cared for by a MICU in the prehospital setting. These observational results need to be confirmed by prospective studies.
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Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients. J Clin Med 2020; 9:jcm9093025. [PMID: 32962227 PMCID: PMC7563105 DOI: 10.3390/jcm9093025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting. METHODS We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12-0.41, p < 10-3) with a corresponding area under curve (AUC) of 0.91 (95% CI: 0.85-0.98). HI significantly differed between patients with and without prehospital intubation (1.0 ± 1.0 vs. 3.6 ± 1.8, respectively; p < 10-3). ROC curve analysis defined the optimal HI threshold as 1.3. Bivariate analysis revealed that HI <1.3 was significantly, positively associated with prehospital intubation (OR, 38.38; 95% CI: 11.57-146.54; p < 10-3). Multivariate logistic regression analysis demonstrated that prehospital intubation was significantly associated with HI (adjusted odds ratio (ORa), 0.20; 95% CI: 0.06-0.45; p < 10-3) and HI <3 (ORa, 51.08; 95% CI: 7.83-645.06; p < 10-3). After adjustment for confounders, the ORa between HI <1.3 and prehospital intubation was 3.6 (95% CI: 1.95-5.08; p < 10-3). CONCLUSION An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.
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