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Kanakaris NK, Bouamra O, Lecky F, Giannoudis PV. Severe trauma with associated pelvic fractures: The impact of regional trauma networks on clinical outcome. Injury 2023:S0020-1383(23)00348-0. [PMID: 37085351 DOI: 10.1016/j.injury.2023.04.006] [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: 04/23/2023]
Abstract
Lately, the care of severely injured patients in the United Kingdom has undergone a significant transformation. The establishment of regional trauma networks (RTN) with designated Major Trauma Centers (MTCs) and satellite hospitals called Trauma Units (TUs) has centralized the care of severely injured patients in the MTCs. Pelvic fractures are notoriously linked with hypovolemic shock or even death from excessive blood loss. The aim of this prospective cohort study is to compare the profile of severely injured patients with combined pelvic fractures and their mortality between two different distinct eras of an advanced healthcare system. Anonymized consecutive patient records submitted to TARN UK between 2002 and 2017 by NHS England hospitals were analyzed. Records of patients without a pelvic fracture, or with isolated pelvic fractures (no other serious injury with abbreviated injury scale AIS >2) were excluded. All patients with known outcomes were included and were divided into 2 distinct periods (pre-RTN era: between January 2002 and March 2008 (control group); and RTN era April 2013 to June 2017 (study group)). Data from the transition period from April 2008 to March 2013 were excluded to minimize the effect of variations between the developing networks and MTCs during that era. Overall, the study group included 10,641 patients, whereas the control group was 3152 patients, with a median age of 52.4 and 35.1 years and an ISS of 24 and 27 respectively. A systolic blood pressure below 90mmHg was observed in 7.2% of patients in the study group and 10.4% in the control group. A significant increase of the median time to death (from 8hrs to 188hrs) was observed between the two eras. The cumulative mortality of severely injured patients with pelvic fractures decreased significantly from 17.8% to 12.4% (p<0.0001). The recorded improvement of survivorship in the subgroup of severely injured patients with a pelvic fracture (32% lower in the post-RTN than in the pre-RTN period: OR 1.32 (95% CI 1.21 - 1.44), following the first 5 years of established regional trauma networks in NHS England, is encouraging, and should be attributed to a wide range of factors that translate to all levels of trauma care.
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Affiliation(s)
- Nikolaos K Kanakaris
- LEEDS Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - Omar Bouamra
- Trauma Research and Audit Network, University of Manchester, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Fiona Lecky
- Trauma Research and Audit Network, University of Manchester, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, United Kingdom; Centre for Urgent and Emergency Care REsearch (CURE), Health Services Research Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - Peter V Giannoudis
- LEEDS Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
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Fukaguchi K, Goto T, Yamamoto T, Yamagami H. Experimental Implementation of NSER Mobile App for Efficient Real-Time Sharing of Prehospital Patient Information With Emergency Departments: Interrupted Time-Series Analysis. JMIR Form Res 2022; 6:e37301. [PMID: 35793142 PMCID: PMC9301553 DOI: 10.2196/37301] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources. Objective In this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time). Methods We performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests. Results During the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; −45 seconds; 95% CI −71 to −18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI −2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED. Conclusions The implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use.
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Affiliation(s)
- Kiyomitsu Fukaguchi
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | | | - Tadatsugu Yamamoto
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Hiroshi Yamagami
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
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Janagama SR, Newberry JA, Kohn MA, Rao GR, Strehlow MC, Mahadevan SV. Is AVPU comparable to GCS in critical prehospital decisions? – A cross-sectional study. Am J Emerg Med 2022; 59:106-110. [DOI: 10.1016/j.ajem.2022.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022] Open
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Li Z, Wong LCK, Sultana R, Lim HJ, Tan JWS, Tan QX, Wong JSM, Chia CS, Ong CAJ. A systematic review on quality of life (QoL) of patients with peritoneal metastasis (PM) who underwent pressurized intraperitoneal aerosol chemotherapy (PIPAC). Pleura Peritoneum 2022; 7:39-49. [PMID: 35812010 PMCID: PMC9166188 DOI: 10.1515/pp-2021-0154] [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] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has recently emerged as a palliative alternative for patients with unresectable peritoneal metastasis (PM). Quality of life (QoL) has increasingly been used as an endpoint to evaluate treatment outcomes. This review aims to identify evidence on how PIPAC would impact the QoL of PM patients. Content A systematic review was performed on articles identified from Medline, EMBASE, PsycInfo, and Web of Sciences. A meta-analysis was conducted on further selected studies. ACROBAT-NRSI was attempted to assess the risk of bias (RoB). Summary Nine studies using the EORTC QLQ-C30 questionnaire to assess QoL after repeated PIPAC cycles were identified. Majority was found to be moderately biased and a great extent of heterogeneity was observed. Four studies on PM from either gastric cancer (GC) or epithelial ovarian cancer (EOC) were included for meta-analysis. In 31 GC patients and 104 EOC patients, QoL remained stable in 13/14 and 11/14 EORTC QLQ-C30 scales. PIPAC was inferior to cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in global QoL and functioning but superior in symptom reduction. Outlook PIPAC is a well-tolerated option for most GC and EOC patients with irresectable PM. Future trials are warranted to confirm the findings.
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Affiliation(s)
- Zhenyue Li
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- Duke-NUS Medical School , Singapore , Singapore
| | - Louis Choon Kit Wong
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- Duke-NUS Medical School , Singapore , Singapore
| | | | - Hui Jun Lim
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore , Singapore , Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore , Singapore , Singapore
| | - Qiu Xuan Tan
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore , Singapore , Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke NUS Medical School , Singapore , Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke NUS Medical School , Singapore , Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore , Singapore , Singapore
- Department of Sarcoma , Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital , Singapore , Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore , Singapore , Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke NUS Medical School , Singapore , Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke NUS Medical School , Singapore , Singapore
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Goulet ND, Liu H, Petrone P, Islam S, Glinik G, Joseph DK, Baltazar GA. Smartphone application alerts for early trauma team activation: Millennial technology in healthcare. Surgery 2021; 171:511-517. [PMID: 34210527 DOI: 10.1016/j.surg.2021.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Data access through smartphone applications (apps) has reframed procedure and policy in healthcare, but its impact in trauma remains unclear. Citizen is a free app that provides real-time alerts curated from 911 dispatch data. Our primary objective was to determine whether app alerts occurred earlier than recorded times for trauma team activation and emergency department arrival. METHODS Trauma registry entries were extracted from a level one urban trauma center from January 1, 2018 to June 30, 2019 and compared with app metadata from the center catchment area. We matched entries to metadata according to description, date, time, and location then compared metadata timestamps to trauma team activation and emergency department arrival times. We computed percentage of time the app reported traumatic events earlier than trauma team activation or emergency department arrival along with exact binomial 95% confidence interval; median differences between times were presented along with interquartile ranges. RESULTS Of 3,684 trauma registry entries, 209 (5.7%) matched app metadata. App alerts were earlier for 96.1% and 96.2% of trauma team activation and emergency department arrival times, respectively, with events reported median 36 (24-53, IQR) minutes earlier than trauma team activation and 32 (25-42, IQR) minutes earlier than emergency department arrival. Registry entries for younger males, motor vehicle-related injuries and penetrating traumas were more likely to match alerts (P < .0001). CONCLUSION Apps like Citizen may provide earlier notification of traumatic events and therefore earlier mobilization of trauma service resources. Earlier notification may translate into improved patient outcomes. Additional studies into the benefit of apps for trauma care are warranted.
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Affiliation(s)
- Nicole D Goulet
- NYU Langone Hospital-Brooklyn, Brooklyn, NY. https://twitter.com/nikkiskier
| | - Helen Liu
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY. https://twitter.com/helenhliu
| | - Patrizio Petrone
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY
| | - Shahidul Islam
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY. https://twitter.com/Shah_Biostat
| | | | - D'Andrea K Joseph
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY. https://twitter.com/ddeekjos
| | - Gerard A Baltazar
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY.
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Kelly GS, Clare D. Improving out-of-hospital notification in traumatic cardiac arrests with novel usage of smartphone application. J Am Coll Emerg Physicians Open 2020; 1:618-623. [PMID: 33000080 PMCID: PMC7493493 DOI: 10.1002/emp2.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Timely out-of-hospital notifications in patients with traumatic cardiac arrest are associated improvements in mortality. Details surrounding these events are often limited, and decisions to perform advanced resuscitative procedures must be made based on limited data. This study evaluated the ability of a mobile application (app) called Citizen (sp0n Inc., New York, NY) to address these issues by providing a novel, secondary source of out-of-hospital information in traumatic cardiac arrest. Citizen sends notifications to mobile devices in response to nearby detected public safety events, and we sought to evaluate its utility in prenotification for traumatic cardiac arrest. METHODS This was a retrospective observational study. Patients ≥ 15 years of age with traumatic cardiac arrest attributed to penetrating trauma were included. The 2 coprimary outcomes observed were the time difference between the app notification and emergency medical services notification, and the app's success rate in generating a notification for each patient in traumatic cardiac arrest. RESULTS From February 2, 2019 to October 10, 2019, there were 43 patients who met the criteria for this study. On average, the Citizen app notification arrived 12.9 minutes before emergency medical services radio notification (95% confidence interval, 9.2-16.6; P < 0.001). Citizen generated a notification for 36 of 43 patients (84%). CONCLUSION The Citizen app generates earlier notifications in traumatic cardiac arrest compared with standard radio communications. It also provides a previously unavailable secondary source of information for making rapid resuscitative decisions upon the arrival of the arresting patient to the emergency department. Further research is needed to determine how to optimally integrate the app into existing trauma systems.
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Affiliation(s)
- Geoffrey S. Kelly
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Drew Clare
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Gupta S, Khajanchi M, Solomon H, Raykar NP, Alkire BC, Roy N, Park KB, Kumar V. Traumatic Brain Injury in Mumbai: A Survey of Providers along the Care Continuum. Asian J Neurosurg 2020; 15:627-633. [PMID: 33145217 PMCID: PMC7591204 DOI: 10.4103/ajns.ajns_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/08/2020] [Accepted: 03/31/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment. METHODS Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai. RESULTS A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others. CONCLUSIONS Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Monty Khajanchi
- Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Harris Solomon
- Department of Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nakul P. Raykar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Blake C. Alkire
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, USA
| | - Nobhojit Roy
- National Health System Resource Center, New Delhi, India
| | - Kee B. Park
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Mitra B, Kumar V, O'Reilly G, Cameron P, Gupta A, Pandit AP, Soni KD, Kaushik G, Mathew J, Howard T, Fahey M, Stephenson M, Dharap S, Patel P, Thakor A, Sharma N, Walker T, Misra MC, Gruen RL, Fitzgerald MC. Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study. BMJ Open 2020; 10:e033236. [PMID: 32565447 PMCID: PMC7311027 DOI: 10.1136/bmjopen-2019-033236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING Major trauma centre in India. PARTICIPANTS Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. INTERVENTION A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. MAIN OUTCOME MEASURES The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. RESULTS Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). CONCLUSIONS The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. TRIAL REGISTRATION NUMBER NCT02877342.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Gerard O'Reilly
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Peter Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Amit Gupta
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Amol P Pandit
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Kapil D Soni
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Gaurav Kaushik
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Joseph Mathew
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Teresa Howard
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Madonna Fahey
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Stephenson
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Ambulance Victoria, Doncaster, VIC, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Satish Dharap
- Department of Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Pankaj Patel
- Department of Orthopaedic Surgery, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Advait Thakor
- Department of Emergency Medicine, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Meical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Tony Walker
- Ambulance Victoria, Doncaster, VIC, Australia
| | - Mahesh C Misra
- Surgical Disciplines, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Russell L Gruen
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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Belhumeur V, Malo C, Nadeau A, Hegg-Deloye S, Gagné AJ, Émond M. Trauma team leaders in Canada: A national survey. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619847338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The availability, composition and activation criteria for trauma teams vary across different health care systems, but little is known about these features in the Canadian health system. The aim of this study is to provide a description of the current trauma team available in Level 1 and 2 centres across Canada. Methods In 2017, using a modified Dillman technique, a survey was sent to 210 health professionals across all Canadian trauma care facilities, including questions that focused on (1) the presence and the composition of a trauma team, (2) the established criteria to activate this team and (3) the initial patient care. Results Overall, 107 (57%) completed surveys were received. Only 22 (11.7%) were from Level 1 or 2 centre and considered for compilation. Seventeen respondents have a trauma team in their centre, and they all shared their criteria for activating their team (1–27 different indications). The suspected injuries, the judgment of the emergency physician, the systolic blood pressure, the Glasgow Coma Score and the respiratory rate were the most frequently mentioned items. In the presence of a pre-hospital care warning, the initial assessment of a severely injured patient is exclusively completed by a member of the trauma team for only 35.1% of the respondents. For 11.8% of respondents, trauma team coordinates airway management. For 64.7% of participants, the trauma team leader is the dedicated care provider to accompany patients until the final destination. Conclusions The results suggest a great variability across Canada, regarding the roles assumed by the trauma team but also regarding the activation criteria leading them to take action.
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Affiliation(s)
| | - Christian Malo
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec City, Canada
| | - Alexandra Nadeau
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Sandrine Hegg-Deloye
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Anne-Julie Gagné
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec City, Canada
- Axe Santé des Populations et Pratiques Optimales en santé, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Canada
- Centre de Recherche sur les Soins et Les Services de Première Ligne de l'Université Laval (CRSSPL-UL), Quebec City, Canada
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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Shivasabesan G, O'Reilly GM, Mathew J, Fitzgerald MC, Gupta A, Roy N, Joshipura M, Sharma N, Cameron P, Fahey M, Howard T, Cheung Z, Kumar V, Jarwani B, Soni KD, Patel P, Thakor A, Misra M, Gruen RL, Mitra B. Establishing a Multicentre Trauma Registry in India: An Evaluation of Data Completeness. World J Surg 2019; 43:2426-2437. [PMID: 31222639 DOI: 10.1007/s00268-019-05039-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The completeness of a trauma registry's data is essential for its valid use. This study aimed to evaluate the extent of missing data in a new multicentre trauma registry in India and to assess the association between data completeness and potential predictors of missing data, particularly mortality. METHODS The proportion of missing data for variables among all adults was determined from data collected from 19 April 2016 to 30 April 2017. In-hospital physiological data were defined as missing if any of initial systolic blood pressure, heart rate, respiratory rate, or Glasgow Coma Scale were missing. Univariable logistic regression and multivariable logistic regression, using manual stepwise selection, were used to investigate the association between mortality (and other potential predictors) and missing physiological data. RESULTS Data on the 4466 trauma patients in the registry were analysed. Out of 59 variables, most (n = 51; 86.4%) were missing less than 20% of observations. There were 808 (18.1%) patients missing at least one of the first in-hospital physiological observations. Hospital death was associated with missing in-hospital physiological data (adjusted OR 1.4; 95% CI 1.02-2.01; p = 0.04). Other significant associations with missing data were: patient arrival time out of hours, hospital of care, 'other' place of injury, and specific injury mechanisms. Assault/homicide injury intent and occurrence of chest X-ray were associated with not missing any of first in-hospital physiological variables. CONCLUSION Most variables were well collected. Hospital death, a proxy for more severe injury, was associated with missing first in-hospital physiological observations. This remains an important limitation for trauma registries.
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Affiliation(s)
- Gowri Shivasabesan
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Gerard M O'Reilly
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Mathew
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- Trauma Service, The Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Amit Gupta
- Division of Trauma Surgery and Critical Care, All India Institute of Medical Science, New Delhi, India
| | - Nobhojit Roy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Surgical Unit, BARC Hospital (Govt. of India), Mumbai, India
| | | | - Naveen Sharma
- Department of Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Peter Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Madonna Fahey
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- Tasmanian Health Service, Hobart, Australia
| | - Teresa Howard
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Zoe Cheung
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Vineet Kumar
- Lokmanya Tilak General Hospital and Municipal Medical College, Mumbai, India
| | | | - Kapil Dev Soni
- Division of Trauma Surgery and Critical Care, All India Institute of Medical Science, New Delhi, India
| | - Pankaj Patel
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Advait Thakor
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Mahesh Misra
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - Russell L Gruen
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- National Trauma Research Institute, The Alfred Hospital, 85-89 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Maliziola C, Frigerio S, Lanzarone S, Barale A, Berardino M, Clari M. Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study. Int Emerg Nurs 2019; 44:20-24. [PMID: 30824337 DOI: 10.1016/j.ienj.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 01/20/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen. OBJECTIVE This study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment. METHODS A retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria. RESULTS Data from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients' death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%. CONCLUSION This study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients' health outcome.
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Affiliation(s)
| | - Simona Frigerio
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Salvatore Lanzarone
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Alessandra Barale
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Maurizio Berardino
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
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