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Kayser LE, Spolsdoff DE, Vakkalanka JP, Hoefer TJ, Walker CA, Georgakakos PK. Assessing Efficiency in a Static-Based 9-1-1 Ambulance Service: An Analysis of Operational Performance Metrics. PREHOSP EMERG CARE 2024:1-5. [PMID: 38805385 DOI: 10.1080/10903127.2024.2360672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/28/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES This study sought to evaluate performance indicators to assist a static-based 9-1-1 agency in defining its response efficiency. METHODS Initial assessment of three metrics-unit hour utilization (UHU), fractile response intervals, and level 0 frequency (occurrence when no ambulances are available to respond)-suggested the agency's response over its four coverage zones was inefficient, so an operational change was implemented: an ambulance was relocated from one service area to another to improve the overall response productivity. A 2-year retrospective analysis was performed to determine the impact ambulance relocation had on the three targeted measurements. RESULTS The operational change resulted in a statistically significant change in unit hour utilization, a non-significant increase in fractile response intervals, and a statistically significant reduction in level 0 frequency from pre- to post-operational change times. CONCLUSIONS These findings suggest a way to evaluate the efficiency of static-based ambulance deployment and potentially identify strategies for redeployment.
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Affiliation(s)
| | - Devin E Spolsdoff
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | | | | | - Peter K Georgakakos
- Johnson County Ambulance Service, Iowa City, Iowa
- Department of Emergency Medicine, Division of EMS, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Maya P, Moran B, Khan M, Yehuda H, Adi G, Joseph DJ, Boris K. Immediate versus expedient emergent laparotomy in unstable isolated abdominal trauma patients. Ann R Coll Surg Engl 2024. [PMID: 38836369 DOI: 10.1308/rcsann.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Unstable abdominal trauma patients should be treated with emergent laparotomy. However, few studies have evaluated the association between time to surgery and survival in these patients. We aimed to assess the influence of time to laparotomy on outcomes in blunt and penetrating unstable abdominal trauma patients. METHODS This retrospective study includes patients with abdominal injuries, systolic blood pressure <90mmHg on arrival, admitted in Israel during 2000-2018. Data regarding patients' characteristics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), time to surgery, length of hospital stay and mortality were collected via The Israeli National Trauma Registry. RESULTS Overall, 69 blunt and 127 penetrating injury patients were included in the study. For blunt and penetrating trauma patients with ISS ≤14, no differences in outcome were found between patients who underwent laparotomy within 60min of admission and those who underwent laparotomy within 60-120min of admission. In patients with blunt trauma, ISS ≥16, and GCS <15, mortality was higher in the immediate laparotomy group (p = 0.004 and 0.049, respectively). CONCLUSIONS In patients with a penetrating injury, no differences in mortality between immediate and expedient laparotomy were demonstrated. In patients with a blunt injury, with ISS ≥16 and GCS <15, mortality was higher among the immediate laparotomy group.
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Affiliation(s)
- P Maya
- Schneider Children's Medical Center, Petah Tikva, Israel
- Tel Aviv University, Israel
| | - B Moran
- Tel Aviv University, Israel
- Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Israel
| | - M Khan
- Brighton and Sussex Medical School, UK
| | - H Yehuda
- Tel Aviv University, Israel
- Shamir Medical Center, Be'er Ya'akov, Israel
| | - G Adi
- Tel Aviv University, Israel
| | | | - K Boris
- Hillel Yaffe Medical Center, Hadera, Israel
- Technion, Haifa, Israel
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Meredith ME, Steimle LN, Radke SM. The implications of using maternity care deserts to measure progress in access to obstetric care: a mixed-integer optimization analysis. BMC Health Serv Res 2024; 24:682. [PMID: 38811929 PMCID: PMC11137923 DOI: 10.1186/s12913-024-11135-4] [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] [Received: 10/30/2023] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Lack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and mortality. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access. METHODS We formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women who lack access to obstetric care. We define regions with a lack of access as either maternity care deserts, designated by the March of Dimes to be counties with no obstetric care facility or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey. RESULTS Out of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both maternity care desert and further than 50 miles from CCO services. Our optimization analysis suggests that at least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. However, the expansion of 8 facilities would ensure all women in Georgia live within 50 miles of CCO services. CONCLUSIONS Current measures of access to obstetric care may not be sufficient for evaluating access and planning action toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to meet obstetric care needs.
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Affiliation(s)
- Meghan E Meredith
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Dr NW, Atlanta, GA, 30318, United States
| | - Lauren N Steimle
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Dr NW, Atlanta, GA, 30318, United States.
| | - Stephanie M Radke
- Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics, Iowa City, IA, United States
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Grisel B, Gordee A, Kuchibhatla M, Ginsberg Z, Agarwal S, Haines K. Outcomes by time-to-OR for penetrating abdominal trauma patients. Am J Emerg Med 2024; 79:144-151. [PMID: 38432154 DOI: 10.1016/j.ajem.2024.02.018] [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: 11/18/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. STUDY DESIGN Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level. RESULTS Odds of mortality for patients at slow facilities was 1.095; 95% CI: 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI: 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI:0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p-value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI: 0.993, 0.999; p = 0.004). CONCLUSION Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome.
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Affiliation(s)
- Braylee Grisel
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Alexander Gordee
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA.
| | | | - Zachary Ginsberg
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Suresh Agarwal
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Krista Haines
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Meredith ME, Steimle LN, Radke SM. The implications of using maternity care deserts to measure progress in access to obstetric care: A mixed-integer optimization analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.31.23297779. [PMID: 37961292 PMCID: PMC10635247 DOI: 10.1101/2023.10.31.23297779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Lack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and mortality. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access. Methods We formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women who lack access to obstetric care. We define regions with a lack of access as either maternity care deserts, designated by the March of Dimes to be counties with no obstetric care facility or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey. Results Out of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both maternity care desert and further than 50 miles from CCO services. Our optimization analysis suggests that at least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. However, and the expansion of 8 facilities would ensure all women in Georgia live within 50 miles of CCO services. Conclusions Current measures of access to obstetric care may not be sufficient for evaluating access and planning action toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to meet obstetric care needs.
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Whitaker J, Amoah AS, Dube A, Rickard R, Leather AJM, Davies J. Access to quality care after injury in Northern Malawi: results of a household survey. BMC Health Serv Res 2024; 24:131. [PMID: 38268016 PMCID: PMC10809521 DOI: 10.1186/s12913-023-10521-8] [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: 06/03/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Most injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury. METHODS We administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (> 30 or 1-29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 h. The reason for those not seeking care was asked. RESULTS Most households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 h. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p < 0.001), stayed overnight at a facility (22.9% vs 15.4% P = 0.047), attended a second place of care (50.3% vs 19.9%, P < 0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142). CONCLUSION Injuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Abena S Amoah
- Malawi Epidemiology and Intervention Research Unit (Formerly Karonga Prevention Study), Chilumba, Malawi
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (Formerly Karonga Prevention Study), Chilumba, Malawi
| | - Rory Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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Breeding T, Rosander A, Abella M, Martinez B, Maka P, Elkbuli A. Retrospective Study of EMS Scene Times and Mortality in Penetrating Trauma Patients: Improving Transport Standards and Patient Outcomes. Am Surg 2024; 90:46-54. [PMID: 37489560 DOI: 10.1177/00031348231191224] [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] [Indexed: 07/26/2023]
Abstract
BACKGROUND This study aimed to determine the impact of emergency medical service (EMS) scene time variability on adult and pediatric trauma patient outcomes with moderate or severe penetrating injuries. METHODS This retrospective study analyzed the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) database between 2017 and 2020 to evaluate the relationship between EMS scene time on adult and pediatric patients with moderate to severe injuries. Primary outcomes included Dead on Arrival (DOA) to the Emergency Department (ED), ED mortality, 24-hour mortality, and in-hospital mortality. Multivariable logistic regression models were used to examine the association of each EMS scene time category and mortality. RESULTS Adult patients with 10-30 minutes of EMS scene time had increased odds of experiencing ED mortality, 24-hour mortality, and in-hospital mortality. Adults with >30 minutes of EMS scene time were more likely to be DOA to the ED. There was no significant association with mortality for patients with <10 minutes of EMS scene time. In the pediatric subset of patients, those with 10-30 minutes of EMS scene time were more likely to experience ED mortality and in-hospital mortality. CONCLUSION EMS scene times less than 10 minutes were associated with the greatest odds of survival, supporting the "load and go" theory for penetrating trauma. Our study suggests that even an EMS scene time of 10-30 minutes results in a significantly increased risk of mortality, and further efforts are needed to improve scene time through improved EMS and hospital policies.
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Affiliation(s)
- Tessa Breeding
- Dr. Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | | | - Brian Martinez
- Dr. Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Piueti Maka
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Burdick KJ, Perez Coulter A, Tirabassi M. Prehospital Transport Time and Outcomes for Pediatric Trauma: A National Study. J Surg Res 2023; 292:144-149. [PMID: 37619499 DOI: 10.1016/j.jss.2023.07.041] [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: 12/05/2022] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Historically, emergency medical services have aimed to deliver trauma patients to definitive care within the 60 min (min) "Golden Hour" to optimize survival. There is little evidence to support or refute this for pediatric trauma. The objective of this investigation was to describe national trends in prehospital transport time, in relation to the "Golden Hour," and pediatric trauma outcomes. METHODS Retrospective cohort study of patients (<15 y old) receiving emergency medical services trauma transport between 2017 and 2019. Transport time (less than or greater than 60 min) was the exposure variable, and analyses were adjusted for injury severity score (ISS). Continuous variables with a normal distribution were compared by t-test was and skewed variables were compared by Mann-Whitney U-test. Categorical variables were compared by Chi-Square test. RESULTS 54,489 patients met our criteria: 49,628 blunt and 4861 penetrating. Most patients (62.2%) had transport times less than 60 min: 30,389 (61.2%) blunt and 3479 (71.6%) penetrating. The overall mortality rate was 1.6%, 1.2% for blunt and 5.5% for penetrating. For blunt trauma, mortality was higher for transport times less than 60 min (1.5%). For penetrating trauma, mortality was lower for transport times less than 60 min (0.7%). Mean ISS was greater for blunt (7.9) compared to penetrating trauma (7.1), and greater for both trauma types with transport times less than 60 min. For both trauma types, mean length of stay was significantly longer for transport times greater than 60 min, when adjusting for ISS (P < 0.001). CONCLUSIONS We did not find evidence that prehospital transport within the "Golden Hour" had a substantial association with survival, though it may be associated with length of stay. There are many factors contributing to trauma outcomes, so efforts should continue to expand access and pediatric readiness.
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Affiliation(s)
- Kendall J Burdick
- T.H. Chan School of Medicine, Worcester, Massachusetts; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
| | - Aixa Perez Coulter
- Department of Surgery, Baystate Medical Center, Springfield, Massachusetts
| | - Michael Tirabassi
- T.H. Chan School of Medicine, Worcester, Massachusetts; Department of Surgery, Baystate Medical Center, Springfield, Massachusetts
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Amin D, Manhan AJ, Pak-Harvey E, Roser SM, Smith RN, Abramowicz S. Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck? J Oral Maxillofac Surg 2023; 81:1383-1390. [PMID: 37572693 DOI: 10.1016/j.joms.2023.07.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S) The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES Patient, injury, and hospital-related covariates were collected. ANALYSES Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.
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Affiliation(s)
- Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, University of Rochester Medical School, Rochester, NY.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Ezra Pak-Harvey
- Medical Student, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University Residency Program Director, Chef of service Grady Memorial Hospital, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Emory University School of Medicine Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shelly Abramowicz
- Professor of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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Zimmerman A, Elahi C, Hernandes Rocha TA, Sakita F, Mmbaga BT, Staton CA, Vissoci JRN. Machine learning models to predict traumatic brain injury outcomes in Tanzania: Using delays to emergency care as predictors. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002156. [PMID: 37856444 PMCID: PMC10586611 DOI: 10.1371/journal.pgph.0002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023]
Abstract
Constraints to emergency department resources may prevent the timely provision of care following a patient's arrival to the hospital. In-hospital delays may adversely affect health outcomes, particularly among trauma patients who require prompt management. Prognostic models can help optimize resource allocation thereby reducing in-hospital delays and improving trauma outcomes. The objective of this study was to investigate the predictive value of delays to emergency care in machine learning based traumatic brain injury (TBI) prognostic models. Our data source was a TBI registry from Kilimanjaro Christian Medical Centre Emergency Department in Moshi, Tanzania. We created twelve unique variables representing delays to emergency care and included them in eight different machine learning based TBI prognostic models that predict in-hospital outcome. Model performance was compared using the area under the receiver operating characteristic curve (AUC). Inclusion of our twelve time to care variables improved predictability in each of our eight prognostic models. Our Bayesian generalized linear model produced the largest AUC, with a value of 89.5 (95% CI: 88.8, 90.3). Time to care variables were among the most important predictors of in-hospital outcome in our best three performing models. In low-resource settings where delays to care are highly prevalent and contribute to high mortality rates, incorporation of care delays into prediction models that support clinical decision making may benefit both emergency medicine physicians and trauma patients by improving prognostication performance.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Cyrus Elahi
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
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Wu B, Tang Q. A sustainable scheduling system for medical equipment: Towards net zero goals for green healthcare. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:18960-18986. [PMID: 38052585 DOI: 10.3934/mbe.2023839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Shortages of medical equipment, growth in medical waste and carbon emissions have increased healthcare pressures and has a huge impact on the environment. An efficient scheduling of medical equipment will effectively reduce the pressure on healthcare and improve the healthcare system's ability to respond to unexpected disasters. A medical equipment scheduling system was established to improve the sustainable utilization of medical equipment within the healthcare network and to reduce the carbon emissions of the healthcare process. First, this paper combines medical equipment information to establish a medical equipment scheduling decision model that considers pollution to filter qualified medical equipment for scheduling. Then, this paper constructs and solves a multi-objective robust optimization model by collecting the patient's travel information and the medical pressure information of each region. In addition, to meet dynamic healthcare needs, a dynamic medical equipment configuration framework was constructed to enhance the flexibility of equipment scheduling and the resilience of the healthcare network. Combined with case studies, the results show that the medical equipment scheduling system can help decision makers make quick scheduling decisions and achieve sustainable use of medical equipment, with a corresponding increase in medical equipment utilization of 12.25% and a reduction in carbon emissions of 26.50%. The study will help enhance healthcare resource utilization and contribute to the net-zero goal of green healthcare.
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Affiliation(s)
- Baotong Wu
- School of management, Shenyang University of Technology, Shenyang, 110870, China
| | - Qi Tang
- School of management, Shenyang University of Technology, Shenyang, 110870, China
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Nilsbakken IMW, Cuevas-Østrem M, Wisborg T, Sollid S, Jeppesen E. Effect of urban vs. remote settings on prehospital time and mortality in trauma patients in Norway: a national population-based study. Scand J Trauma Resusc Emerg Med 2023; 31:53. [PMID: 37798724 PMCID: PMC10557189 DOI: 10.1186/s13049-023-01121-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: 02/08/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Norway has a diverse population pattern and often long transport distances from injury sites to hospitals. Also, previous studies have found an increased risk of trauma-related mortality in remote areas in Norway. Studies on urban vs. remote differences on trauma outcomes from other countries are sparse and they report conflicting results.The aim of the present study was to investigate differences in prehospital time intervals in urban and remote areas in Norway and assess how prehospital time and urban vs. remote settings were associated with mortality in the Norwegian trauma population. METHODS We performed a population-based study of trauma cases included in the Norwegian Trauma Registry from 2015 to 2020. 28,988 patients met the inclusion criteria. Differences in study population characteristics and prehospital time intervals (response time, on-scene time and transport time) were analyzed. The Norwegian Centrality Index score was used for urban vs. remote classification. Descriptive statistics and relevant non-parametric tests with effect size measurements were used. A binary logistic regression model, adjusted for confounding factors, was performed. RESULTS The prehospital time intervals increased significantly from urban to remote areas.Adjusted for control variables we found a significant relationship between prolonged on-scene time and higher odds of mortality. Also, suburban areas compared with remote areas were associated with higher odds of mortality. CONCLUSION In this nationwide study comparing prehospital time intervals in urban and remote areas, we found that prehospital time intervals in remote areas exceeded those in urban areas. Prolonged on-scene time was found to be associated with higher odds of mortality, but remoteness itself was not.
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Affiliation(s)
- Inger Marie Waal Nilsbakken
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Mathias Cuevas-Østrem
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torben Wisborg
- Interprofessional rural research team – Finnmark, Faculty of Health Sciences, University of Tromsø – the Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
| | - Stephen Sollid
- Prehospital Division, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Jeppesen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Siripakarn Y, Triniti L, Srivilaithon W. Association of Scene Time with Mortality in Major Traumatic Injuries Arrived by Emergency Medical Service. J Emerg Trauma Shock 2023; 16:156-160. [PMID: 38292276 PMCID: PMC10824223 DOI: 10.4103/jets.jets_35_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Trauma is a major cause of death worldwide, and prehospital care is critical to improve patient outcomes. However, there is controversy surrounding the effectiveness of limiting scene time to 10 min or less in the care of major trauma patients. This study aimed to investigate the association between scene time and mortality in major trauma patients. Methods A retrospective cohort study was conducted on major trauma patients treated by the Thammasat University Hospital Emergency Medical Services (EMS) team from 2020 to 2022. We included traumatic adult patients who had an injury severity score (ISS) of 16 or higher. The primary outcome was 24-h mortality. Multivariable risk regression analysis was used to evaluate the independent effect of scene time on 24-h mortality. Results A total of 104 patients were included, of whom 11.5% died within 24 h. After adjusting for age, systolic blood pressure, Glasgow Coma Scale, and ISS, patients who had a scene time over 10 min showed a significant association with mortality (33.3% vs. 8.7%, P = 0.031). Intravenous fluid administration at the scene showed a trend toward a significant association with mortality. Conclusions This study provides evidence to support the importance of minimizing scene time for major trauma patients. The findings suggest that a balance between timely interventions and adequate resources should be considered to optimize patient outcomes. Further studies to investigate the impact of prehospital interventions on trauma patient outcomes are needed.
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Affiliation(s)
- Yaowapha Siripakarn
- Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Laongdao Triniti
- Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Winchana Srivilaithon
- Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Dinh M, Singh H, Deans C, Pople G, Bendall J, Sarrami P. Prehospital times and outcomes of patients transported using an ambulance trauma transport protocol: A data linkage analysis from New South Wales Australia. Injury 2023; 54:110988. [PMID: 37574381 DOI: 10.1016/j.injury.2023.110988] [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: 12/22/2022] [Revised: 07/13/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Prehospital trauma systems are designed to ensure optimal survival from critical injuries by triaging and transporting such patients to the most appropriate hospital in a timely manner. OBJECTIVES We sought to evaluate whether prehospital time and location (metropolitan versus non-metropolitan) were associated with 30-day mortality in a cohort of patients transported by road ambulance using a trauma transport protocol. METHODS Data linkage analysis of routinely collected ambulance and hospital data across all public hospitals in New South Wales (NSW). The data linkage cohort included adult patients (age ≥ 16years) transported by NSW Ambulance, where a T1 Major Trauma Transport Protocol was documented by paramedic crews and transported by road to a public hospital emergency department in NSW for two years between January 2019 and December 2020. The outcomes of interest were prehospital times (response time, scene time and transport time) and 30-day mortality due to injury. RESULTS 9012 cases were identified who were transported to an emergency department with T1 protocol indication. Median prehospital transport times were longer in non-metropolitan road transports [n = 3,071, 98 min (71-126)] compared to metropolitan transports [n = 5,941, 65 min (53-80), p < 0.001]. There was no significant difference in 30-day mortality between the two groups (1.24% vs 1.65%, p = 0.13). In the subgroup of patients with abnormal vital signs, the only predictors of mortality were increasing age, presence of severe injury (OR 24.87, 95%CI 11.02, 56.15, p < 0.001), and arrival at a non-trauma facility (OR 3.01, 95%CI 1.26, 7.20, p < 0.05). Increasing transport times were not found to increase the odds of 30-day mortality. DISCUSSION In the context of an inclusive trauma system and an established prehospital major trauma protocol, increasing prehospital transport times and scene location were not associated with increased mortality.
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Affiliation(s)
- Michael Dinh
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia; Sydney Medical School, the University of Sydney, Australia
| | - Hardeep Singh
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia
| | | | | | | | - Pooria Sarrami
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia; South Western Sydney Clinical School, University of New South Wales, Australia.
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Knapp J, Doppmann P, Huber M, Meuli L, Albrecht R, Sollid S, Pietsch U. Pre-hospital endotracheal intubation in severe traumatic brain injury: ventilation targets and mortality-a retrospective analysis of 308 patients. Scand J Trauma Resusc Emerg Med 2023; 31:46. [PMID: 37700380 PMCID: PMC10498564 DOI: 10.1186/s13049-023-01115-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) remains one of the main causes of mortality and long-term disability worldwide. Maintaining physiology of brain tissue to the greatest extent possible through optimal management of blood pressure, airway, ventilation, and oxygenation, improves patient outcome. We studied the quality of prehospital care in severe TBI patients by analyzing adherence to recommended target ranges for ventilation and blood pressure, prehospital time expenditure, and their effect on mortality, as well as quality of prehospital ventilation assessed by arterial partial pressure of CO2 (PaCO2) at hospital admission. METHODS This is a retrospective cohort study of all TBI patients requiring tracheal intubation on scene who were transported to one of two major level 1 trauma centers in Switzerland between January 2014 and December 2019 by Swiss Air Rescue (Rega). We assessed systolic blood pressure (SBP), end-tidal partial pressure of CO2 (PetCO2), and PaCO2 at hospital admission as well as prehospital and on-scene time. Quality markers of prehospital care (PetCO2, SBP, prehospital times) and prehospital ventilation (PaCO2) are presented as descriptive analysis. Effect on mortality was calculated by multivariable regression analysis and a logistic general additive model. RESULTS Of 557 patients after exclusions, 308 were analyzed. Adherence to blood pressure recommendations was 89%. According to PetCO2, 45% were normoventilated, and 29% had a SBP ≥ 90 mm Hg and were normoventilated. Due to the poor correlation between PaCO2 and PetCO2, only 33% were normocapnic at hospital admission. Normocapnia at hospital admission was strongly associated with reduced probability of mortality. Prehospital and on-scene times had no impact on mortality. CONCLUSIONS PaCO2 at hospital admission is strongly associated with mortality risk, but normocapnia is achieved only in a minority of patients. Therefore, the time required for placement of an arterial cannula and prehospital blood gas analysis may be warranted in severe TBI patients requiring on-scene tracheal intubation.
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Affiliation(s)
- Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, 3010, Bern, Switzerland.
- Swiss Air-Rescue (Rega), Zurich, Switzerland.
| | - Pascal Doppmann
- Swiss Air-Rescue (Rega), Zurich, Switzerland
- Department of Anaesthesiology and Pain Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, 3010, Bern, Switzerland
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Roland Albrecht
- Swiss Air-Rescue (Rega), Zurich, Switzerland
- Department of Emergency Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephen Sollid
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Urs Pietsch
- Department of Emergency Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Wycoff M, Hoag TP, Okeke RI, Culhane JT. Association of Time to Definitive Hemostasis With Mortality in Patients With Solid Organ Injuries. Cureus 2023; 15:e45401. [PMID: 37854760 PMCID: PMC10581328 DOI: 10.7759/cureus.45401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction The Golden Hour is a term used in the trauma setting to refer to the first 60 minutes after injury. Traditionally, definitive care within this period was believed to dramatically increase a patient's survival. Though the period of 60 minutes is unlikely to represent a point of distinct inflection in survival, the effect of time to definitive care on survival remains incompletely understood. This study aims to measure the association of time to definitive hemostasis with mortality in patients with solid organ injuries as well as the effect of survival bias and a form of selection bias known as indication by severity on the relationship between time to treatment and survival. Methodology This is a retrospective cohort study using data obtained from the American College of Surgeons National Trauma Data Bank (NTDB) from the years 2017 through 2019 selecting patients treated for blunt liver, spleen, or kidney injury who required angioembolization or surgical hemostasis within six hours. A Cox proportional hazards regression was used to analyze time to death. The association of probability of death with time was examined with a multivariate logistic regression initially treating the relationship as linear and subsequently transforming time to hemostasis with restricted cubic splines to model a non-linear association with the outcome. To model survival and indication by severity bias, we created a computer-generated data set and used LOESS regressions to display curves of the simulated data. Results The multivariate Cox proportional hazards analysis shows a coefficient of negative 0.004 for minutes to hemostasis with an adjusted hazard ratio of 0.9959 showing the adjusted hazard of death slightly diminishes with each increasing minute to hemostasis. The likelihood ratio chi-square difference between the model with time to hemostasis included as a linear term versus the model with the restricted cubic spline transformation is 97.46 (p<0.0001) showing the model with restricted cubic splines is a better fit for the data. The computer-generated data simulating treatment of solid organ injury with no programmed bias displays an almost linear association of mortality with increased treatment delay. When indications by severity bias and survival bias are introduced, the risk of death decreases with time to hemostasis as in the real-world data. Conclusion Decreasing mortality with increasing delay to hemostasis in trauma patients with solid organ injury is likely due to confounding due to indication by severity and survival bias. After taking these biases into account, the association of delayed hemostasis with better survival is not likely due to the benefit of delay but rather the delay sorts patients by severity of injury with those more likely to die being treated first. These biases are extremely difficult to eliminate which limits the ability to measure the true effect of delay with retrospective data. The findings may however be of value as a predictive model to anticipate the acuity of a patient after an interval of unavoidable delay such as with a long transfer time.
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Affiliation(s)
- Michaela Wycoff
- General Surgery, MercyOne Des Moines Medical Center, Des Moines, USA
| | - Thomas P Hoag
- General Surgery, Saint Louis University School of Medicine, Saint Louis, USA
| | - Raymond I Okeke
- General Surgery, Saint Louis University School of Medicine, Saint Louis, USA
| | - John T Culhane
- General Surgery, Saint Louis University School of Medicine, Saint Louis, USA
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Chea H, Kim H. Assessing trauma center accessibility in the Southeastern region of the U.S. to improve healthcare efficacy using an anti-covering approach. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002230. [PMID: 37594934 PMCID: PMC10437900 DOI: 10.1371/journal.pgph.0002230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/08/2023] [Indexed: 08/20/2023]
Abstract
Accessibility to trauma centers is vital for the patients of severe motor vehicle crashes. Many vehicle crash fatalities failed to reach the proper emergency medical services since the accident location was far away from trauma centers. The spatial discordance between the service coverage area of trauma centers and actual locations of motor vehicle accidents delays the definitive medical care and results in death or disability. Many fatalities would have been prevented if the patients had a chance to get proper treatment in time at Southeastern region of the U.S. Also, the accessibility to trauma centers from the actual locations of motor vehicle accidents is different in the Southeastern region. This research aimed to facilitate the accessibility to trauma centers for severe motor vehicle crash patients in the Southeastern region. The analyses are conducted to assess current trauma center accessibility and suggest the optimal locations of future trauma centers using the Anti-covering location model for trauma centers (TraCt model). This study found that existing trauma centers failed to serve many demands, and the actual coverages of the current locations of trauma centers over potential demands are highly different in each Southeastern state. TraCt model is applied to each Southeastern state, and its solutions provide better coverage for demand locations. However, the TraCt model for each state tends to choose too many facilities, with excessively supplied facilities across the Southeastern region. The excessive service supply issue is addressed by applying the TraCt Model to a broader spatial extent. TraCt model applied to the entire Southeastern region and most of the demand, over 98% covered by the service coverage of optimal facility locations with 15 additional facilities. This research proves that the GIS and TraCt model applied to the broader spatial extent works well with increasing trauma medical service beneficiaries while providing a minimum number of additional facilities.
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Affiliation(s)
- Heewon Chea
- Department of Geography, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Hyun Kim
- Department of Geography, University of Tennessee, Knoxville, Tennessee, United States of America
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18
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Bhattarai HK, Bhusal S, Barone-Adesi F, Hubloue I. Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review. Prehosp Disaster Med 2023; 38:495-512. [PMID: 37492946 PMCID: PMC10445116 DOI: 10.1017/s1049023x23006088] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/08/2023] [Accepted: 06/17/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs. METHODS This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies. CONCLUSIONS The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.
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Affiliation(s)
- Hari Krishna Bhattarai
- Program in Global Health, Humanitarian Aid and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy, and Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Francesco Barone-Adesi
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium Research Group on Emergency and Disaster Medicine, Medical School, Vrije Universiteit Brussel, Brussels, Belgium
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Mroz EJ, Willis T, Thomas C, Janes C, Singini D, Njungu M, Smith M. Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia. Int J Health Geogr 2023; 22:17. [PMID: 37525198 PMCID: PMC10391775 DOI: 10.1186/s12942-023-00338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Seasonal floods pose a commonly-recognised barrier to women's access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women's walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access.
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Affiliation(s)
- Elizabeth Jade Mroz
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK.
| | - Thomas Willis
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Thomas
- Lincoln Centre for Water & Planetary Health, University of Lincoln, Lincoln, LN6 7DW, UK
| | - Craig Janes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Douglas Singini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mwimanenwa Njungu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mark Smith
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
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Baker H, Erdman MK, Christiano A, Strelzow JA. Team Approach: The Unstable Trauma Patient. JBJS Rev 2023; 11:01874474-202306000-00001. [PMID: 37276267 DOI: 10.2106/jbjs.rvw.22.00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
» A multidisciplinary, integrated, and synergistic team approach to the unstable polytrauma patient is critical to optimize outcomes, minimize morbidity, and reduce mortality.» The use of Advanced Trauma Life Support protocols helps standardize the assessment and avoid missing critical injuries» Effective and open dialog with consulting specialists is paramount for effective team-based care.» Orthopaedic surgeons should play an important role in the rapid assessment of potentially life-threatening and/or limb-threatening injuries including pelvic ring disruption, open fractures with substantial blood loss, and dysvascular limbs.
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Affiliation(s)
- Hayden Baker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
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Amato S, Benson JS, Stewart B, Sarathy A, Osler T, Hosmer D, An G, Cook A, Winchell RJ, Malhotra AK. Current patterns of trauma center proliferation have not led to proportionate improvements in access to care or mortality after injury: An ecologic study. J Trauma Acute Care Surg 2023; 94:755-764. [PMID: 36880704 PMCID: PMC10208642 DOI: 10.1097/ta.0000000000003940] [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: 08/20/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Timely access to high-level (I/II) trauma centers (HLTCs) is essential to minimize mortality after injury. Over the last 15 years, there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality. METHODS A geocoded list of HLTC, with year designated, was obtained from the American Trauma Society, and 60-minute travel time polygons were created using OpenStreetMap data. Census block group population centroids, county population centroids, and American Communities Survey data from 2005 and 2020 were integrated. Age-adjusted nonoverdose injury mortality was obtained from CDC Wide-ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation. Geographically weighted regression models were used to identify independent predictors of HLTC access and injury mortality. RESULTS Over the 15-year (2005-2020) study period, the number of HLTC increased by 31.0% (445 to 583), while population access to HLTC increased by 6.9% (77.5-84.4%). Despite this increase, access was unchanged in 83.1% of counties, with a median change in access of 0.0% (interquartile range, 0.0-1.1%). Population-level age-adjusted injury mortality rates increased by 5.39 per 100,000 population during this time (60.72 to 66.11 per 100,000). Geographically weighted regression controlling for population demography and health indicators found higher median income and higher population density to be positively associated with majority (≥50%) HLTC population coverage and negatively associated with county-level nonoverdose mortality. CONCLUSION Over the past 15 years, the number of HLTC increased 31%, while population access to HLTC increased only 6.9%. High-level (I/II) trauma center designation is likely driven by factors other than population need. To optimize efficiency and decrease potential oversupply, the designation process should include population level metrics. Geographic information system methodology can be an effective tool to assess optimal placement. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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22
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Hirner S, Dhakal J, Broccoli MC, Ross M, Calvello Hynes EJ, Bills CB. Defining measures of emergency care access in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e067884. [PMID: 37068910 PMCID: PMC10111883 DOI: 10.1136/bmjopen-2022-067884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Over 50% of annual deaths in low-income and middle-income countries (LMICs) could be averted through access to high-quality emergency care. OBJECTIVES We performed a scoping review of the literature that described at least one measure of emergency care access in LMICs in order to understand relevant barriers to emergency care systems. ELIGIBILITY CRITERIA English language studies published between 1 January 1990 and 30 December 2020, with one or more discrete measure(s) of access to emergency health services in LMICs described. SOURCE OF EVIDENCE PubMed, Embase, Web of Science, CINAHL and the grey literature. CHARTING METHODS A structured data extraction tool was used to identify and classify the number of 'unique' measures, and the number of times each unique measure was studied in the literature ('total' measures). Measures of access were categorised by access type, defined by Thomas and Penchansky, with further categorisation according to the 'Three Delay' model of seeking, reaching and receiving care, and the WHO's Emergency Care Systems Framework (ECSF). RESULTS A total of 3103 articles were screened. 75 met full study inclusion. Articles were uniformly descriptive (n=75, 100%). 137 discrete measures of access were reported. Unique measures of accommodation (n=42, 30.7%) and availability (n=40, 29.2%) were most common. Measures of seeking, reaching and receiving care were 22 (16.0%), 46 (33.6%) and 69 (50.4%), respectively. According to the ECSF slightly more measures focused on prehospital care-inclusive of care at the scene and through transport to a facility (n=76, 55.4%) as compared with facility-based care (n=57, 41.6%). CONCLUSIONS Numerous measures of emergency care access are described in the literature, but many measures are overaddressed. Development of a core set of access measures with associated minimum standards are necessary to aid in ensuring universal access to high-quality emergency care in all settings.
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Affiliation(s)
- Sarah Hirner
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jyotshila Dhakal
- College Undergraduate Degree Programs & Studies, University of Colorado Denver, Denver, Colorado, USA
| | | | - Madeline Ross
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Emilie J Calvello Hynes
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Djaja YP, Silitonga J, Dilogo IH, Mauffrey OJ. The management of pelvic ring fractures in low-resource environments: review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:515-523. [PMID: 36333484 DOI: 10.1007/s00590-022-03420-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Although improvement of pelvic trauma care has been successful in decreasing mortality rates in major trauma centers, such changes have not been implemented in low-resource environments such as low-middle-income countries (LMICs). This review details the evaluation and management of pelvic ring fractures and recommends improvements for trauma care in low-resource environments. Prehospital management revolves around basic life support techniques. Application of non-invasive pelvic circumferential compression devices, such as bed sheet or pelvic binders, can be performed as early as the scene of the accident. Upon arrival at the emergency department, rapid clinical evaluation and immediate resuscitation should be performed. Preperitoneal pelvic packing and external fixation devices have been considered as important first-line management tools to achieve bleeding control in hemodynamically unstable patients. After patient stabilization, immediate referral is mandated if the hospital does not have an orthopedic surgeon or facilities to perform complex pelvic/acetabular surgery. Telemedicine platforms have emerged as one of the key solutions for informing decision-making. However, unavailable referral systems and inaccessible transportation systems act as significant barriers in LMICs. Tendencies toward more "old-fashioned" protocols and conservative treatments are often justified especially for minimally displaced fractures. But when surgery is needed, it is important to visualize the fracture site to obtain and maintain a good reduction in the absence of intraoperative imaging. Minimizing soft tissue damage, reducing intraoperative blood loss, and minimizing duration of surgical interventions are vital when performing pelvic surgery in a limited intensive care setting.
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Affiliation(s)
- Yoshi Pratama Djaja
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
| | - Jamot Silitonga
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Océane J Mauffrey
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Jiao J, Degen N, Azimian A. Identifying Hospital Deserts in Texas Before and During the COVID-19 Outbreak. TRANSPORTATION RESEARCH RECORD 2023; 2677:813-825. [PMID: 37153188 PMCID: PMC10149497 DOI: 10.1177/03611981221095745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
In this study, we proposed a GIS-based approach to analyzing hospital visitors from January to June 2019 and January to June 2020 with the goal of revealing significant changes in the visitor demographics. The target dates were chosen to observe the effect of the first wave of COVID-19 on the visitor count in hospitals. The results indicated that American Indian and Pacific Islander groups were the only ones that sometimes showed no shift in visitor levels between the studied years. For 19 of the 28 hospitals in Austin, TX, the average distance traveled to those hospitals from home increased in 2020 compared with 2019. A hospital desert index was devised to identify the areas in which the demand for hospitals is greater than the current hospital supply. The hospital desert index considers the travel time, location, bed supply, and population. The cities located along the outskirts of metropolitan regions and rural towns showed more hospital deserts than dense city centers.
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Affiliation(s)
- Junfeng Jiao
- Urban Information Lab, University of
Texas at Austin, Austin, TX
| | - Nathaniel Degen
- Urban Information Lab, University of
Texas at Austin, Austin, TX
- Nathaniel Degen,
| | - Amin Azimian
- Urban Information Lab, University of
Texas at Austin, Austin, TX
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Lamary M, Bertoni CB, Schwabenbauer K, Ibrahim J. Neonatal Golden Hour: a review of current best practices and available evidence. Curr Opin Pediatr 2023; 35:209-217. [PMID: 36722754 DOI: 10.1097/mop.0000000000001224] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Recommendations made by several scientific bodies advocate for adoption of evidence-based interventions during the first 60 min of postnatal life, also known as the 'Golden Hour', to better support the fetal-to-neonatal transition. Implementation of a Golden Hour protocol leads to improved short-term and long-term outcomes, especially in extremely premature and extreme low-birth-weight (ELBW) neonates. Unfortunately, several recent surveys have highlighted persistent variability in the care provided to this vulnerable population in the first hour of life. RECENT FINDINGS Since its first adoption in the neonatal ICU (NICU) in 2009, published literature shows a consistent benefit in establishing a Golden Hour protocol. Improved short-term outcomes are reported, including reductions in hypothermia and hypoglycemia, efficiency in establishing intravenous access, and timely initiation of fluids and medications. Additionally, long-term outcomes report decreased risk for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP). SUMMARY Critical to the success and sustainability of any Golden Hour initiative is recognition of the continuous educational process involving multidisciplinary team collaboration to ensure coordination between providers in the delivery room and beyond. Standardization of practices in the care of extremely premature neonates during the first hour of life leads to improved outcomes. VIDEO ABSTRACT http://links.lww.com/MOP/A68 .
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Affiliation(s)
| | - C Briana Bertoni
- Division of Newborn Medicine, UPMC Magee-Womens Hospital/Children's Hospital of Pittsburgh, USA
| | - Kathleen Schwabenbauer
- Division of Newborn Medicine, UPMC Magee-Womens Hospital/Children's Hospital of Pittsburgh, USA
| | - John Ibrahim
- Division of Newborn Medicine, UPMC Magee-Womens Hospital/Children's Hospital of Pittsburgh, USA
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Peng HT, Siddiqui MM, Rhind SG, Zhang J, da Luz LT, Beckett A. Artificial intelligence and machine learning for hemorrhagic trauma care. Mil Med Res 2023; 10:6. [PMID: 36793066 PMCID: PMC9933281 DOI: 10.1186/s40779-023-00444-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
Artificial intelligence (AI), a branch of machine learning (ML) has been increasingly employed in the research of trauma in various aspects. Hemorrhage is the most common cause of trauma-related death. To better elucidate the current role of AI and contribute to future development of ML in trauma care, we conducted a review focused on the use of ML in the diagnosis or treatment strategy of traumatic hemorrhage. A literature search was carried out on PubMed and Google scholar. Titles and abstracts were screened and, if deemed appropriate, the full articles were reviewed. We included 89 studies in the review. These studies could be grouped into five areas: (1) prediction of outcomes; (2) risk assessment and injury severity for triage; (3) prediction of transfusions; (4) detection of hemorrhage; and (5) prediction of coagulopathy. Performance analysis of ML in comparison with current standards for trauma care showed that most studies demonstrated the benefits of ML models. However, most studies were retrospective, focused on prediction of mortality, and development of patient outcome scoring systems. Few studies performed model assessment via test datasets obtained from different sources. Prediction models for transfusions and coagulopathy have been developed, but none is in widespread use. AI-enabled ML-driven technology is becoming integral part of the whole course of trauma care. Comparison and application of ML algorithms using different datasets from initial training, testing and validation in prospective and randomized controlled trials are warranted for provision of decision support for individualized patient care as far forward as possible.
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Affiliation(s)
- Henry T Peng
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada.
| | - M Musaab Siddiqui
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | - Jing Zhang
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | | | - Andrew Beckett
- St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
- Royal Canadian Medical Services, Ottawa, K1A 0K2, Canada
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Younger DS. Mild traumatic brain injury and sports-related concussion. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:475-494. [PMID: 37620086 DOI: 10.1016/b978-0-323-98817-9.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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28
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Coming in hot: Police transport and prehospital time after firearm injury. J Trauma Acute Care Surg 2022; 93:656-663. [DOI: 10.1097/ta.0000000000003689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ortiz C, Vela J, Contreras C, Belmar F, Paul I, Zinco A, Ramos JP, Ottolino P, Achurra P, Jarufe N, Alseidi A, Varas J. A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program. Surg Endosc 2022; 36:8441-8450. [PMID: 35237901 PMCID: PMC8890468 DOI: 10.1007/s00464-022-09098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. METHODS A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training. RESULTS Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. CONCLUSION An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.
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Affiliation(s)
- Catalina Ortiz
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Belmar
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ivan Paul
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Analia Zinco
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Juan Pablo Ramos
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Ottolino
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Department of Surgery, Clínica Las Condes, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julian Varas
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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A Geographical Analysis of Access to Trauma Centers from US National Parks in 2018. Prehosp Disaster Med 2022; 37:794-799. [PMID: 36263736 DOI: 10.1017/s1049023x22001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibility of trauma care from national parks by calculating the travel time by ground and air from each park to its nearest trauma center. Using these calculations, the percentage of parks by census region with timely access to a trauma center was determined. METHODS This was a cross-sectional study analyzing travel times by ground and air transport between national parks and their closest adult advanced trauma center (ATC) in 2018. A list of parks was compiled from the National Parks Service (NPS) website, and the location of trauma centers from the 2018 National Emergency Department Inventory (NEDI)-USA database. Ground and air transport times were calculated using Google Maps and ArcGIS, with medians and interquartile ranges reported by US census region. Percentage of parks by region with timely trauma center access-defined as access within 60 minutes of travel time-were determined based on these calculated travel times. RESULTS In 2018, 83% of national parks had access to an adult ATC within 60 minutes of air travel, while only 26% had timely access by ground. Trauma center access varied by region, with median travel times highest in the West for both air and ground transport. At a national level, national parks were unequally distributed, with the West housing the most parks of all regions. CONCLUSION While most national parks had timely access to a trauma center by air travel, significant gaps in access remain for ground, the extent of which varies greatly by region. To improve the accessibility of trauma center expertise from national parks, the study highlights the potential that increased implementation of trauma telehealth in emergency departments (EDs) may have in bridging these gaps.
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Alpman N, Tekiner AS. Investigating the Approaches and Knowledge Levels of Parents of Children at the Ages of 0-14 About Basic First Aid. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The accidents experienced in childhood are a public health problem due to their potential outcomes, and they require collaboration with family physicians. This study aimed to investigate the basic first aid approaches and knowledge levels of parents who bring their children to the outpatient clinics of the Department of Family Medicine and Social Pediatrics at Ankara University School of Medicine.
Methods: This descriptive and cross-sectional study conducted between 19 October 2020 and 16 November 2020 was approved by the Ankara University Human Research Ethics Committee. The data were collected face-to-face using a survey form and were analyzed using the IBM SPSS 15.0 package program.
Results: In this study, 229 parents in total were reached. 55.9% of the participants had first aid training and a higher rate of considering themselves adequate about first aid. The participants with first aid training, those with high income, those with high education levels, and those with a driver's license answered more questions correctly.
Conclusion: Although our study participants had relatively very high education levels, there were issues about which their first aid knowledge was lacking, and these results revealed the importance of providing parents with first aid training once again.
Keywords: family practice, child care, parents, first aid, accidents
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Alayande B, Chu KM, Jumbam DT, Kimto OE, Musa Danladi G, Niyukuri A, Anderson GA, El-Gabri D, Miranda E, Taye M, Tertong N, Yempabe T, Ntirenganya F, Byiringiro JC, Sule AZ, Kobusingye OC, Bekele A, Riviello RR. Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review. CURRENT TRAUMA REPORTS 2022; 8:66-94. [PMID: 35692507 PMCID: PMC9168359 DOI: 10.1007/s40719-022-00229-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/02/2023]
Abstract
Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action. Supplementary Information The online version contains supplementary material available at 10.1007/s40719-022-00229-1.
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Affiliation(s)
- Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Alliance Niyukuri
- Hope Africa University, Bujumbura, Burundi
- Mercy Surgeons-Burundi, Research Department, Bujumbura, Burundi
- Mercy James Center for Paediatric Surgery and Intensive Care-Blantyre, Blantyre, Malawi
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Deena El-Gabri
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Mulat Taye
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ngyal Tertong
- International Fellow, Paediatric Orthopaedic Surgery Department of Orthopaedics, Sheffield Children’s Hospital, Sheffield, UK
| | - Tolgou Yempabe
- Orthopaedic and Trauma Unit, Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | - Faustin Ntirenganya
- University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- NIHR Research Hub On Global Surgery, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital of Kigali, Kigali, Rwanda
- NIHR Research Hub On Global Surgery, University of Rwanda, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Olive C. Kobusingye
- Makerere University School of Public Health, Kampala, Uganda
- George Institute for Global Health, Sydney, Australia
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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Bannone E, Marchegiani G, Perri G, Procida G, Vacca PG, Cattelani A, Salvia R, Bassi C. Postoperative serum hyperamylasemia (POH) predicts additional morbidity after pancreatoduodenectomy: It is not all about pancreatic fistula. Surgery 2022; 172:715-722. [PMID: 35636983 DOI: 10.1016/j.surg.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/16/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association between postoperative serum hyperamylasaemia (POH) and morbidity has been hypothesized but rarely explored once occurring with or without (POH-exclusive) a combined postoperative pancreatic fistula (POPF). METHODS Analysis of patients who consecutively underwent pancreaticoduodenectomy from 2016 to 2020. POH was defined as serum amylase activity greater than the institutional upper limit of normal (52 U/L), persisting within the first 48 hours postoperatively (postoperative day [POD] 1 and 2). RESULTS Among 852 patients, 15.8% developed POH-exclusive. Compared with patients without POH or POPF (64.3%), they showed a significantly higher postoperative burden (Clavien-Dindo ≥II: 52.6% vs 30.8%) with increased rates of bacteraemia (12.6% vs 6%), pleural effusion (13.3% vs 5.3%), postpancreatectomy haemorrhage (13.3% vs 7.5%), postpancreatectomy acute pancreatitis (PPAP) (10.3% vs 0%), and organ site infections (18.5% vs 10.9%; all P < .05). A total of 13.8% experienced POH with POPF leading to the worse outcome. The combined occurrence of POH with POPF led to a shorter median time to morbidity (3 PODs, 95% confidence interval [CI] 2.2-3.7 vs 6 PODs, 95% CI 4.2-8; P < .001) than patients experiencing POPF-exclusive (5.9%). In all, 46.6% of POH patients developed POPF. Body mass index (BMI) (odds ratio [OR] 1.1), male sex (OR 2.1), increased drain fluid amylase on POD 1 (OR 1.001), and increased C-reactive protein (OR 1.01) were independent risk factors for POPF once POH has occurred. CONCLUSION POH has relevant postoperative clinical implications, independently from POPF occurrence. Developing POH with POPF leads to an earlier onset of higher postoperative burdens. Once POH is diagnosed, risk factors for additional POPF could identify patients who may benefit from additional surveillance, specific drains protocols, and preventive strategies.
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Affiliation(s)
- Elisa Bannone
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giampaolo Perri
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppa Procida
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Pier Giuseppe Vacca
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alice Cattelani
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
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Access to care following injury in Northern Malawi, a comparison of travel time estimates between Geographic Information System and community household reports. Injury 2022; 53:1690-1698. [PMID: 35153068 DOI: 10.1016/j.injury.2022.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injuries disproportionately impact low- and middle-income countries like Malawi. The Lancet Commission on Global Surgery's indicators include the population proportion accessing laparotomy and open fracture care, key trauma interventions, within two hours. The "Golden Hour" for receiving facility-based resuscitation also guides injury care system strengthening. Firstly, we estimated the proportion of the local population able to reach primary, secondary and tertiary facility care within two and one hours using Geographic Information System (GIS) analysis. Secondly, we compared community household-reported with GIS-estimated travel time. METHODS Using information from a Health and Demographic Surveillance Site (Karonga, Malawi) on road network, facility location, and local staff-estimated travel speeds, we used a GIS-generated friction surface to calculate the shortest travel time from all households to each facility serving the population. We surveyed community households who reported travel time to their preferred, closest, government secondary and tertiary facilities. For recently injured community members, time to reach facility care was recorded. To assess the relationship between community household-reported travel time and GIS-estimated travel time, we used linear regression to generate a proportionality constant. To assess associations and agreement between injured patient-reported and GIS-estimated travel time, we used Kendall rank and Cohen's kappa tests. RESULTS Using GIS, we estimated 79.1% of households could reach any secondary facility, 20.5% the government secondary facility, and 0% the government tertiary facility, within two hours. Only 28.2% could reach any secondary facility within one hour, 0% for the government secondary facility. Community household-reported travel time exceeded GIS-estimated travel time. The proportionality constant was 1.25 (95%CI 1.21-1.30) for the closest facility, 1.28 (95%CI 1.23-1.34) for the preferred facility, 1.45 (95%CI 1.33-1.58) for the government secondary facility, and 2.12 (95%CI 1.84-2.41) for tertiary care. Comparing injured patient-reported with GIS-estimated travel time, the correlation coefficient was 0.25 (SE 0.047) and Cohen's kappa was 0.15 (95%CI 0.078-0.23), suggesting poor agreement. DISCUSSION Most households couldn't reach government secondary care within recognised thresholds indicating poor temporal access. Since GIS-estimated travel time was shorter than community-reported travel time, the true proportion may be lower still. GIS derived estimates of population emergency care access in similar contexts should be interpreted accordingly.
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Duchesne J, Slaughter K, Puente I, Berne JD, Yorkgitis B, Mull J, Sperry J, Tessmer M, Costantini T, Berndtson AE, Kai T, Rokvic G, Norwood S, Meadows K, Chang G, Lemon BM, Jacome T, Van Sant L, Paul J, Maher Z, Goldberg AJ, Madayag RM, Pinson G, Lieser MJ, Haan J, Marshall G, Carrick M, Tatum D. Impact of time to surgery on mortality in hypotensive patients with noncompressible torso hemorrhage: An AAST multicenter, prospective study. J Trauma Acute Care Surg 2022; 92:801-811. [PMID: 35468112 DOI: 10.1097/ta.0000000000003544] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to hemorrhage control. We hypothesized that shorter times to surgical intervention for hemorrhage control would decrease mortality in hypotensive patients with NCTH. METHODS This was an AAST-sponsored multicenter, prospective analysis of hypotensive patients aged 15+ years who presented with NCTH from May 2018 to December 2020. Hypotension was defined as an initial systolic blood pressure (SBP) ≤ 90 mm Hg. Primary outcomes of interest were time to surgical intervention and in-hospital mortality. RESULTS There were 242 hypotensive patients, of which 48 died (19.8%). Nonsurvivors had higher mean age (47.3 vs. 38.8; p = 0.02), higher mean New Injury Severity Score (38 vs. 29; p < 0.001), lower admit systolic blood pressure (68 vs. 79 mm Hg; p < 0.01), higher incidence of vascular injury (41.7% vs. 21.1%; p = 0.02), and shorter median (interquartile range, 25-75) time from injury to operating room start (74 minutes [48-98 minutes] vs. 88 minutes [61-128 minutes]; p = 0.03) than did survivors. Multivariable Cox regression showed shorter time from emergency department arrival to operating room start was not associated with improved survival (p = 0.04). CONCLUSION Patients who died arrived to a trauma center in a similar time frame as did survivors but presented in greater physiological distress and had significantly shorter times to surgical hemorrhage intervention than did survivors. This suggests that even expediting a critically ill patient through the current trauma system is not sufficient time to save lives from NCTH. Civilian prehospital advance resuscitative care starting from the patient first contact needs special consideration. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level III.
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Affiliation(s)
- Juan Duchesne
- From the Tulane University School of Medicine (J.D., K.S., D.T.), New Orleans, Louisiana; Broward Health Medical Center (I.P., J.D.B.), Fort Lauderdale; University of Florida-Jacksonville (B.Y., J.M.), Jacksonville, Florida; University of Pittsburgh (J.S., M.T.), Pittsburgh, Pennsylvania; UC San Diego Medical Center (T.C., A.E.B.), San Diego, California; University of Kentucky Chandler Medical Center (T.K., G.R.), Lexington, Kentucky; University of Texas Health Tyler (S.N., K.M.), Tyler, Texas; Mount Sinai Hospital (G.C., B.M.L.), Chicago, Illinois; Our Lady of the Lake Regional Medical Center (T.J.), Baton Rouge, Louisiana; University of New Mexico Hospital (L.V.S., J.P.), Albuquerque, New Mexico; Temple University Hospital (Z.M., A.J.G.), Philadelphia, Pennsylvania; St. Anthony Hospital (R.M.M., G.P.), Lakewood, Colorado; Research Medical Center (M.J.L.), Kansas City, Missouri; Ascension Via Christi Hospital St. Francis (J.H.), Wichita, Kansas; and Medical City Plano (G.M., M.C.), Plano, Texas
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Profile and Outcome of Victims of an Earthquake in an Aging Society: A Population-Based Descriptive Study of the Earthquake in Osaka, Japan, on June 18, 2018. Disaster Med Public Health Prep 2022; 17:e149. [PMID: 35414369 DOI: 10.1017/dmp.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study is to reveal the characteristics and outcomes of patients injured in a major earthquake and who were transported to a hospital by ambulance. METHODS This study was a retrospective descriptive epidemiological study including all patients who were injured after a major earthquake struck Osaka Prefecture on June 18, 2018, and were transported to a hospital by ambulance. The main outcome was the prognosis at each hospital's emergency department. RESULTS In total, 214 patients were included in the analysis. Their median age was 74 years (IQR, 54-82); 53 (24.8%) were men and 161 (75.2%) were women. The median time from ambulance call to arrival at the scene was 10 min (IQR, 7-15), and the median time from ambulance call to the hospital arrival was 37 min (IQR, 30-51). Ninety-seven patients (45.3%) were admitted to a hospital, 114 patients (53.3%) were discharged home to and from the emergency department, and 3 patients (1.4%) died. Among the patients discharged to home from the emergency department, the most common pathological condition was head bruising in 16 patients. CONCLUSIONS This study revealed the profile of injured patients transported by ambulances after an earthquake that struck an aging society.
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Moafa HN, van Kuijk SM, Moukhyer ME, Alqahtani DM, Haak HR. Variation in on-scene time of emergency medical services and the extent of the difference of on-scene time between genders: a retrospective population-based registry study in Riyadh Province, Saudi Arabia. BMJ Open 2022; 12:e052481. [PMID: 35296475 PMCID: PMC8928325 DOI: 10.1136/bmjopen-2021-052481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify the intergender variation of on-scene time (OST) for highly urgent emergency cases conveyed by emergency medical services (EMS) in Saudi Arabia and to assess other predictors of OST and hypothesise for possible factors delaying OST. DESIGN A retrospective population-based registry study. SETTING Riyadh Province is the largest province in terms of population and the second in terms of geographical area. PARTICIPANTS All highly urgent transported patients from the scene to emergency departments, be they medical emergencies or trauma emergencies during 2018. OUTCOME MEASURE OST difference between men and women transported by EMS. RESULTS In total, 21 878 patients were included for analysis: 33.9% women and 66.1% men. The median OST for women was 22 min (IQR 15-30) and 18 min (IQR 11-26) for men (p<0.001); for medical cases, median OST was 23 min (IQR 16-31) for women compared with 20 min (IQR 13 - 29) for men (p<0.001); for trauma cases, the median OST of both sexes was equal. We found the following additional predictors of OST: factors of emergency type, sex, age category, geographical areas, type of ambulance vehicle and hospital type were all significantly associated with OST in the crude or adjusted analyses. Factors of emergency type, sex, age category, geographical areas, type of ambulance vehicle and hospital type were also significantly associated with the odds of OST of more than 15 min in the crude and adjusted regression analyses. CONCLUSIONS The median OST was longer than 15 min for more than half of transported cases. For medical cases, women had a longer median OST than men. Additional predictors associated with prolonged OST were the patient's age, area (ie, urban vs rural), type of ambulance vehicle and season. These findings are hypothesis generating and require further studies.
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Affiliation(s)
- Hassan N Moafa
- Health Services Management, Jazan University Faculty of Public Health and Tropical Medicine, Jazan, Saudi Arabia
- Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mohammed E Moukhyer
- Emergency Medical Services, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Public Health Programmes, School of Medicine, University of Limerick, Limerick, Ireland
| | - Dhafer M Alqahtani
- Saudi Red Crescent Authority, Department of Innovation and Development, Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | - Harm R Haak
- Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands
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The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One. Crit Care Explor 2022; 4:e0642. [PMID: 35261978 PMCID: PMC8893307 DOI: 10.1097/cce.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Approximately one in 30 patients with acute respiratory failure (ARF) undergoes an inter-ICU transfer. Our objectives are to describe inter-ICU transfer patterns and evaluate the impact of timing of transfer on patient-centered outcomes.
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Waalwijk JF, van der Sluijs R, Lokerman RD, Fiddelers AAA, Hietbrink F, Leenen LPH, Poeze M, van Heijl M. The impact of prehospital time intervals on mortality in moderately and severely injured patients. J Trauma Acute Care Surg 2022; 92:520-527. [PMID: 34407005 DOI: 10.1097/ta.0000000000003380] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Modern trauma systems and emergency medical services aim to reduce prehospital time intervals to achieve optimal outcomes. However, current literature remains inconclusive on the relationship between time to definitive treatment and mortality. The aim of this study was to investigate the association between prehospital time and mortality. METHODS All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) who were transported from the scene of injury to a trauma center by ground ambulances of the participating emergency medical services between 2015 and 2017 were included. Exposures of interest were total prehospital time, on-scene time, and transport time. Outcomes were 24-hour and 30-day mortality. Generalized linear models including inverse probability weights for several potential confounders were constructed. A generalized additive model was constructed to enable visual inspection of the association. RESULTS We included 22,525 moderately and severely injured patients. Twenty-four-hour and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24-hour (relative risk [RR], 1.029; 95% confidence interval, 1.018-1.040) and 30-day mortality (RR, 1.013; 1.008-1.017). We found that this association was also present in patients with severe injuries, traumatic brain injury, severe abdominal injury, and stab or gunshot wound. An on-scene time of 20 minutes or longer demonstrated a strong association with 24-hour (RR, 1.797; 1.406-2.296) and 30-day mortality (RR, 1.298; 1.180-1.428). Total prehospital (24-hour: RR, 0.998; 0.990-1.007; 30-day: RR, 1.000, 0.997-1.004) and transport (24-hour: RR, 0.996; 0.982-1.010; 30-day: RR, 0.995; 0.989-1.001) time were not associated with mortality. CONCLUSION A prolonged on-scene time is associated with mortality in moderately and severely injured patients, which suggests that a reduced on-scene time may be favorable for these patients. In addition, transport time was found not to be associated with mortality. LEVEL OF EVIDENCE Prognostic and Epidemiologic; level III.
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Affiliation(s)
- Job F Waalwijk
- From the Department of Surgery (J.F.W., R.D.L., F.H., L.P.H.L., M.v.H.), University Medical Center Utrecht, Utrecht; Department of Surgery (J.F.W., M.P.), Maastricht University Medical Center; Network Acute Care Limburg (J.F.W., A.A.A.F., M.P.), Maastricht University Medical Center, Maastricht, the Netherlands; Center for Artificial Intelligence in Medicine and Imaging (R.v.d.S.), Stanford University, Stanford; and Department of Surgery (M.v.H.), Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, the Netherlands
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Assessing Trauma Center Accessibility for Healthcare Equity Using an Anti-Covering Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031459. [PMID: 35162486 PMCID: PMC8835095 DOI: 10.3390/ijerph19031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
Motor vehicle accidents are one of the most prevalent causes of traumatic injury in patients needing transport to a trauma center. Arrival at a trauma center within an hour of the accident increases a patient's chances of survival and recovery. However, not all vehicle accidents in Tennessee are accessible to a trauma center within an hour by ground transportation. This study uses the anti-covering location problem (ACLP) to assess the current placement of trauma centers and explore optimal placements based on the population distribution and spatial pattern of motor vehicle accidents in 2015 through 2019 in Tennessee. The ACLP models seek to offer a method of exploring feasible scenarios for locating trauma centers that intend to provide accessibility to patients in underserved areas who suffer trauma as a result of vehicle accidents. The proposed ACLP approach also seeks to adjust the locations of trauma centers to reduce areas with excessive service coverage while improving coverage for less accessible areas of demand. In this study, three models are prescribed for finding optimal locations for trauma centers: (a) TraCt: ACLP model with a geometric approach and weighted models of population, fatalities, and spatial fatality clusters of vehicle accidents; (b) TraCt-ESC: an extended ACLP model mitigating excessive service supply among trauma center candidates, while expanding services to less served areas for more beneficiaries using fewer facilities; and (c) TraCt-ESCr: another extended ACLP model exploring the optimal location of additional trauma centers.
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Population Access to Hospital Emergency Departments: The Spatial Analysis in Public Health Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031437. [PMID: 35162454 PMCID: PMC8835408 DOI: 10.3390/ijerph19031437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
The emergency medical services support the primary health care system. Hospital emergency departments (HEDs), which provide medical assistance to all patients in a state of emergency are of considerable importance to the system. When studying access to HEDs, attention should be focused on spatial relations resulting from the location of HEDs and the places of residence of the potential patients. The aim of the paper is to explain the level of spatial accessibility of HEDs and its changes as a result of organizational and spatial transformations of HEDs' networks in Poland. The research was conducted within two time series, comparing the changes in the distribution of HEDs in 2011 and 2021. GIS techniques were used to measure the distances between emergency departments and places of residence. It was observed that the transformation of the spatial organization of the hospital emergency department network in 2011-2021 resulted in the overall improvement of the spatial accessibility of these facilities, reducing the distance between them and places of residence.
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Direct Admission to the Operating Room for Severe Trauma. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vehicle Dynamics Endured by Patients during Emergency Evacuation—Ambulance versus Helicopter. SAFETY 2022. [DOI: 10.3390/safety8010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the event of a road accident, a quick intervention is crucial. The mobile emergency services take care of patients whose condition requires an emergency repatriation to a hospital, by land in an ambulance or by air in a helicopter. The main criteria for choosing the means of transport are the time required for repatriation and the patient’s more or less critical state of health. Do the vehicle dynamic effects endured by the transported patient have an influence on their health condition? Vehicle dynamics data were recorded with a road data recorder for a period of 3 months, under real conditions of patient repatriation to a hospital; 39 trips were recorded by ambulance and 29 trips by helicopter. Significant differences in speed (average 42 versus 202 km/h) and distance travelled (average 23 versus 85 km) were observed. The sustained effects are similar in helicopters and ambulances. The ambulance causes more abrupt variations in longitudinal and transversal directions, whereas the helicopter has more variations in vertical direction. The vibration level in helicopters is higher than in ambulances. These results can be considered as a first reference baseline for establishing a characterization of transported patients’ exposure to vehicle dynamics.
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Weekend Mortality in an Italian Hospital: Immediate versus Delayed Bedside Critical Care Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020767. [PMID: 35055589 PMCID: PMC8776160 DOI: 10.3390/ijerph19020767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022]
Abstract
Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) (p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.
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Uribe-Leitz T, Matsas B, Dalton MK, Lutgendorf MA, Moberg E, Schoenfeld AJ, Goralnick E, Weissman JS, Hamlin L, Cooper Z, Koehlmoos TP, Jarman MP. Geospatial Analysis of Access to Emergency Cesarean Delivery for Military and Civilian Populations in the US. JAMA Netw Open 2022; 5:e2142835. [PMID: 35006244 PMCID: PMC8749478 DOI: 10.1001/jamanetworkopen.2021.42835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Many women in the US, particularly those living in rural areas, have limited access to obstetric care. Military-civilian partnership could improve access to obstetric care and benefit military personnel, their civilian dependents, and the civilian population as a whole. OBJECTIVE To identify medical facilities within military and civilian geographic areas that present opportunities for military-civilian partnership in obstetric care and to assess whether civilian use of military medical treatment facilities (MTFs) could improve access to emergency cesarean delivery care in the US. DESIGN, SETTING, AND PARTICIPANTS This geospatial epidemiological population-based cross-sectional study was conducted from November 2020 to March 2021. ArcGIS Pro software, version 2.7 (Esri), was used to assess population coverage for TRICARE (military insurance) beneficiaries and civilian populations and to estimate 30-minute travel time to 2392 total military and civilian medical facilities that were capable of providing emergency cesarean delivery care in the continental US. Data on health insurance coverage for TRICARE beneficiaries and their civilian dependents per county were obtained from the American Community Survey tables available through ArcGIS Pro software. Demographic characteristics of the general population were obtained from the 2020 key demographic indicators published by Esri. Race and ethnicity were not examined because the data used for this study were aggregated and did not include further categorization by race or ethnicity. MAIN OUTCOMES AND MEASURES Population coverage rates (measured in percentages) within 30-minute catchment areas, defined as areas that were within a 30-minute travel time to a medical facility capable of providing emergency cesarean delivery care. RESULTS A total of 29 MTFs and 2363 civilian hospitals capable of providing emergency cesarean delivery were identified across the contiguous US. Overall, an estimated 167 759 762 women (3 640 000 TRICARE beneficiaries and 164 119 762 civilians) were included in these service areas. The analysis identified 17 of 29 MTFs (58.6%) capable of providing emergency cesarean delivery care that were located within 30-minute catchment areas. Of those, 3 MTFs were the only facilities capable of providing emergency cesarean delivery care within a 30-minute travel time in those regions, and 14 additional MTFs had catchment areas partially overlapping with civilian hospitals that also covered areas without alternative access to emergency cesarean delivery. Expanded use of these 14 MTFs could enhance access to emergency cesarean delivery care not otherwise covered by current civilian hospitals. CONCLUSIONS AND RELEVANCE In this study, 58.6% of MTFs capable of providing emergency cesarean delivery care were located in areas with the potential to improve access to obstetric care within a 30-minute travel time. Maintenance of MTFs in these important access regions could be prioritized in the context of restructuring MTFs. This prioritization has the potential to improve access to emergency cesarean delivery care for underserved civilian populations in the US, particularly among those living in rural areas.
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Affiliation(s)
- Tarsicio Uribe-Leitz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - Michael K. Dalton
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Monica A. Lutgendorf
- Division of Maternal-Fetal Medicine, Naval Medical Center San Diego, San Diego, California
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Esther Moberg
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew J. Schoenfeld
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Eric Goralnick
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joel S. Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lynette Hamlin
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tracey P. Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Molly P. Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Hassler J, Ceccato V. Socio-spatial disparities in access to emergency health care-A Scandinavian case study. PLoS One 2021; 16:e0261319. [PMID: 34890436 PMCID: PMC8664193 DOI: 10.1371/journal.pone.0261319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Having timely access to emergency health care (EHC) depends largely on where you live. In this Scandinavian case study, we investigate how accessibility to EHC varies spatially in order to reveal potential socio-spatial disparities in access. Distinct measures of EHC accessibility were calculated for southern Sweden in a network analysis using a Geographical Information System (GIS) based on data from 2018. An ANOVA test was carried out to investigate how accessibility vary for different measures between urban and rural areas, and negative binominal regression modelling was then carried out to assess potential disparities in accessibility between socioeconomic and demographic groups. Areas with high shares of older adults show poor access to EHC, especially those in the most remote, rural areas. However, rurality alone does not preclude poor access to EHC. Education, income and proximity to ambulance stations were also associated with EHC accessibility, but not always in expected ways. Despite indications of a well-functioning EHC, with most areas served within one hour, socio-spatial disparities in access to EHC were detected both between places and population groups.
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Affiliation(s)
- Jacob Hassler
- Department of Urban Planning and Environment, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Vania Ceccato
- Department of Urban Planning and Environment, KTH Royal Institute of Technology, Stockholm, Sweden
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Hutchinson E, Osting S, Rutecki P, Sutula T. Diffusion Tensor Orientation as a Microstructural MRI Marker of Mossy Fiber Sprouting After TBI in Rats. J Neuropathol Exp Neurol 2021; 81:27-47. [PMID: 34865073 DOI: 10.1093/jnen/nlab123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) metrics are highly sensitive to microstructural brain alterations and are potentially useful imaging biomarkers for underlying neuropathologic changes after experimental and human traumatic brain injury (TBI). As potential imaging biomarkers require direct correlation with neuropathologic alterations for validation and interpretation, this study systematically examined neuropathologic abnormalities underlying alterations in DTI metrics in the hippocampus and cortex following controlled cortical impact (CCI) in rats. Ex vivo DTI metrics were directly compared with a comprehensive histologic battery for neurodegeneration, microgliosis, astrocytosis, and mossy fiber sprouting by Timm histochemistry at carefully matched locations immediately, 48 hours, and 4 weeks after injury. DTI abnormalities corresponded to spatially overlapping but temporally distinct neuropathologic alterations representing an aggregate measure of dynamic tissue damage and reorganization. Prominent DTI alterations of were observed for both the immediate and acute intervals after injury and associated with neurodegeneration and inflammation. In the chronic period, diffusion tensor orientation in the hilus of the dentate gyrus became prominently abnormal and was identified as a reliable structural biomarker for mossy fiber sprouting after CCI in rats, suggesting potential application as a biomarker to follow secondary progression in experimental and human TBI.
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Affiliation(s)
- Elizabeth Hutchinson
- From the Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA (EH); and Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA (SO, PR, TS)
| | - Susan Osting
- From the Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA (EH); and Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA (SO, PR, TS)
| | - Paul Rutecki
- From the Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA (EH); and Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA (SO, PR, TS)
| | - Thomas Sutula
- From the Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA (EH); and Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA (SO, PR, TS)
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Zhang W, Wu J, Yu L, Chen H, Li D, Shi C, Xiao L, Fan J. Paraffin-Coated Hydrophobic Hemostatic Zeolite Gauze for Rapid Coagulation with Minimal Adhesion. ACS APPLIED MATERIALS & INTERFACES 2021; 13:52174-52180. [PMID: 34554720 DOI: 10.1021/acsami.1c10891] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To solve the problem of strong adhesion and excessive blood loss caused by the use of hydrophilic zeolite gauze (Z-Gauze) in uncontrollable bleeding, we have modified the surface of commercial Z-Gauze with a paraffin coating and prepared a hydrophobic dressing PZ-Gauze. After paraffin coating, the adhesion of Z-Gauze was reduced without an obvious decrease in coagulation activity. The clotting time of the hydrophobic PZ-Gauze was reduced from 378.3 to 154.6 s compared with that of cotton gauze, and the peeling force was decreased from 348.8 to 84.7 mN compared with that of Z-Gauze. Besides, PZ-Gauze can efficiently cut down the blood loss during treatment. On the basis of in vitro and in vivo experiments, it is confirmed that surface hydrophobic modification does not change the procoagulant performance because of the maintained cation exchange capacity of zeolites, and the reduced blood loss as well as enhanced difficulty for fibrin adhesion is attributed to its hydrophobicity. This is different from the traditional gauze procoagulant theories, where gauze hydrophilicity and procoagulant performance are always positively correlated.
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Affiliation(s)
- Wenzhao Zhang
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Jianzhou Wu
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Lisha Yu
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Hao Chen
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Dan Li
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Chaojie Shi
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Liping Xiao
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
| | - Jie Fan
- Key Lab of Applied Chemistry of Zhejiang Province, Department of Chemistry, Zhejiang University, Hangzhou 310027, China
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49
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Udekwu P, Simonson B, Stiles A, Mclntyre S, Tann K, Schiro S. Prolonged Emergency Department Stay at Referring Facilities: A Poor Trauma Performance Improvement Tool. Am Surg 2021; 88:728-733. [PMID: 34732064 DOI: 10.1177/00031348211050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delays in the transfers of injured patients are perceived to increase morbidity and mortality and drive initiatives to limit the emergency department length of stay (LOS) at referring facilities (RF). RF LOS >4 hours is used for performance improvement (PI) with a large review burden with few improvement opportunities. METHODS A statewide trauma registry 2013-2018 was used. Descriptive and inferential statistics including logistic regression were used to evaluate nongeriatric adult patients with ED LOS <12 hours. Paired data analyses utilizing prehospital (PH) and RF variables, vital signs (VS), Glasgow Coma Score-Motor component (GCS-M), RF LOS, mortality, trauma center hospital LOS (HLOS), and intensive care unit (ICU) LOS were performed. RESULTS 13,721 of 56,702 transfer patients were selected. Mortality fell over time in all abbreviated injury score groups. GCS-M and systolic blood pressure (SBP) were correlated with mortality in both prehospital and RF data and highest in patients with abnormal GCS-M or SBP in both settings (38.0%, 30.1%). Examination of mortality over time in the group with abnormal VS showed SBP as the only variable with increasing mortality related to RF LOS. Average HLOS and ICU LOS were longest in patients with abnormal PH and RF SBP and GCS-M. DISCUSSION Support for PI evaluation of RF LOS >4 hours was not identified. Increased survival over time is explained by early transfers of high mortality patients. Our data support existing efficient statewide transfers and recommend PI review of transfer patients with abnormal GCS-M and SBP in a narrower timeframe.
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Affiliation(s)
- Pascal Udekwu
- 10848WakeMed Health and Hospitals, Raleigh, NC, USA.,North Carolina Office of Emergency Medical Services, Raleigh, NC, USA
| | - Brian Simonson
- 24520New Hanover Regional Medical Center, Wilmington, NC, USA.,North Carolina Office of Emergency Medical Services, Raleigh, NC, USA
| | - Anquonette Stiles
- 10848WakeMed Health and Hospitals, Raleigh, NC, USA.,North Carolina Office of Emergency Medical Services, Raleigh, NC, USA
| | - Sarah Mclntyre
- 10848WakeMed Health and Hospitals, Raleigh, NC, USA.,North Carolina Office of Emergency Medical Services, Raleigh, NC, USA
| | - Kimberly Tann
- 10848WakeMed Health and Hospitals, Raleigh, NC, USA.,North Carolina Office of Emergency Medical Services, Raleigh, NC, USA
| | - Sharon Schiro
- 6797University of North Carolina, Chapel Hill, NC, USA.,North Carolina Office of Emergency Medical Services, Raleigh, NC, USA
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Van DB, Song KJ, Shin SD, Ro YS, Jeong J, Bao HL, Duc CN, Kim KH. Association between Scene Time Interval and Survival in EMS-Treated Major Trauma Admitted to the Intensive Care Unit: A Multinational, Multicenter Observational Study. PREHOSP EMERG CARE 2021; 26:600-607. [PMID: 34644245 DOI: 10.1080/10903127.2021.1992053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Major trauma is a major concern in public health and a leading cause of mortality worldwide. This study aimed to evaluate the association between the prehospital scene time interval (STI) and survival in emergency medical service (EMS)-assessed major trauma patients admitted to the intensive care unit (ICU). Methods: A retrospective observational study using the Pan-Asian Trauma Outcomes Study (PATOS) database was conducted. Adult trauma patients with injury severity scores (ISSs) greater than 15 who were admitted to the ICU were selected. EMS STIs were categorized into three groups: short (0-8 minutes), intermediate (9-16 minutes), and long (over 16 minutes). The primary outcome was survival to hospital discharge, and the secondary outcome was good neurological outcome at hospital discharge. Multivariable logistic regression analysis was conducted to calculate odds ratios and confidence intervals, adjusting for age, sex, mechanism of injury, prehospital alertness, prehospital shock index, response time interval, and EMS intervention (airway, oxygen supplementation, and intravenous fluid administration). Sensitivity analysis for patients who underwent surgery or nontraumatic brain injury cases and interaction analysis by EMS intervention were performed. Results: Data from a total of 1,874 eligible patients were analyzed. Intermediate and long STIs showed significant associations with outcomes, with adjusted ORs (95% CI) of 1.21 (1.07-1.38) in the intermediate STI group and 1.74 (1.55-1.96) in the long STI group for survival and 1.37 (1.32-1.40) in the intermediate STI group and 1.31 (1.22-1.41) in the long STI group for neurological outcome. In the sensitivity analysis, the highest ORs were found in the intermediate STI group, with adjusted ORs (95% CI) of 1.40 (1.37-1.42) for survival and 1.32 (1.26-1.38) for neurological outcome. In the interaction analysis, EMS intervention showed a positive interaction effect with an intermediate STI on survival. Conclusion: In EMS-assessed adult major trauma patients admitted to the ICU, we found significant associations between STIs longer than 8 minutes and outcomes. EMS intervention has a positive interaction effect with an intermediate STI on survival. More research is needed to understand the implications of practice for major trauma in the field.
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