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Miller M, Jorm L, Partyka C, Burns B, Habig K, Oh C, Immens S, Ballard N, Gallego B. Identifying prehospital trauma patients from ambulance patient care records; comparing two methods using linked data in New South Wales, Australia. Injury 2024; 55:111570. [PMID: 38664086 DOI: 10.1016/j.injury.2024.111570] [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: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Linked datasets for trauma system monitoring should ideally follow patients from the prehospital scene to hospital admission and post-discharge. Having a well-defined cohort when using administrative datasets is essential because they must capture the representative population. Unlike hospital electronic health records (EHR), ambulance patient-care records lack access to sources beyond immediate clinical notes. Relying on a limited set of variables to define a study population might result in missed patient inclusion. We aimed to compare two methods of identifying prehospital trauma patients: one using only those documented under a trauma protocol and another incorporating additional data elements from ambulance patient care records. METHODS We analyzed data from six routinely collected administrative datasets from 2015 to 2018, including ambulance patient-care records, aeromedical data, emergency department visits, hospitalizations, rehabilitation outcomes, and death records. Three prehospital trauma cohorts were created: an Extended-T-protocol cohort (patients transported under a trauma protocol and/or patients with prespecified criteria from structured data fields), T-protocol cohort (only patients documented as transported under a trauma protocol) and non-T-protocol (extended-T-protocol population not in the T-protocol cohort). Patient-encounter characteristics, mortality, clinical and post-hospital discharge outcomes were compared. A conservative p-value of 0.01 was considered significant RESULTS: Of 1 038 263 patient-encounters included in the extended-T-population 814 729 (78.5 %) were transported, with 438 893 (53.9 %) documented as a T-protocol patient. Half (49.6 %) of the non-T-protocol sub-cohort had an International Classification of Disease 10th edition injury or external cause code, indicating 79644 missed patients when a T-protocol-only definition was used. The non-T-protocol sub-cohort also identified additional patients with intubation, prehospital blood transfusion and positive eFAST. A higher proportion of non-T protocol patients than T-protocol patients were admitted to the ICU (4.6% vs 3.6 %), ventilated (1.8% vs 1.3 %), received in-hospital transfusion (7.9 vs 6.8 %) or died (1.8% vs 1.3 %). Urgent trauma surgery was similar between groups (1.3% vs 1.4 %). CONCLUSION The extended-T-population definition identified 50 % more admitted patients with an ICD-10-AM code consistent with an injury, including patients with severe trauma. Developing an EHR phenotype incorporating multiple data fields of ambulance-transported trauma patients for use with linked data may avoid missing these patients.
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Affiliation(s)
- Matthew Miller
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia; Department of Anesthesia, St George Hospital, Kogarah, NSW 2217 Australia; Centre for Big Data Research in Health at UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Louisa Jorm
- Foundation Director of the Centre for Big Data Research in Health at UNSW Sydney, Kensington 2052, Australia
| | - Chris Partyka
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia; Department of Emergency Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Brian Burns
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia; Royal North Shore Hospital, St Leonards, NSW 2065, Australia; Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Karel Habig
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia
| | - Carissa Oh
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia; Department of Emergency Medicine, St George Hospital, Kogarah, NSW 2217 Australia
| | - Sam Immens
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia
| | - Neil Ballard
- Aeromedical Operations, New South Wales Ambulance, Rozelle, NSW 2039, Australia; Department of Paediatric Emergency Medicine, Sydney Children's Hospital, Randwick, NSW 2031, Australia; Department of Emergency Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Blanca Gallego
- Clinical analytics and machine learning unit, Centre for Big Data Research in Health at UNSW Sydney, Kensington 2052, Australia
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Noël F, Gagnon MP, Lajoie J, Côté M, Caron SM, Martin A, Labrie-Pichette A, Carvalho LP. Inpatient Physical Therapy in Moderate to Severe Traumatic Brain Injury in in Older Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3367. [PMID: 36834061 PMCID: PMC9967343 DOI: 10.3390/ijerph20043367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Around 500/100,000 Canadians experience a traumatic brain injury (TBI) resulting in long-term disabilities and premature death. Physiotherapy is known to positively impact the prognosis of young adults following a TBI. OBJECTIVE This is a scoping review that aimed to identify research topics in physiotherapy interventions for seniors after a TBI, describe potential knowledge gaps, and uncover needs for future research. METHODOLOGY Ten databases were interrogated (January-March 2022). We included texts published after 2010, in English or French, scientific papers, guidelines, and gray literature sources targeting in-hospital, acute-to-subacute interventions for people aged ≥55 years old with a moderate-to-severe TBI. The outcomes sought were physical/functional capacities, injury severity, and quality of life. RESULTS From 1296 articles, 16 were selected. The number of participants from the studies altogether was 248,794. We identified eight retrospectives studies, three clinical trials, and five articles from the gray literature. Articles were classified according to the nature of their analysis and outcomes: (1) interventional studies including physiotherapy (at least 10 types of rehabilitative or preventive interventions were identified); (2) studies evaluating prognostic factors (five factors identified); and (3) recommendations from clinical practical guidelines and other sources (gray literature). Our results provide evidence that physiotherapy is effective in TBI acute rehabilitation for the elderly to prevent complications arising from the primary injury and to improve functional capacities. CONCLUSION The heterogeneity of our results does not allow us to infer the effectiveness of one intervention over another. However, we found that the elderly population benefits from physiotherapy interventions as much as adults, but the gap must be filled with higher-quality studies to make definite recommendations.
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Affiliation(s)
- Florence Noël
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Marie-Pier Gagnon
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Jasmine Lajoie
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Marjorie Côté
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Sarah-Maude Caron
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Abygaël Martin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Alexis Labrie-Pichette
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Livia P. Carvalho
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, University of Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
- Aging Research Center, Centre de Recherche sur le Vieillissement du CIUSSS de l’Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada
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Vallmuur K, McCreanor V, Cameron C, Watson A, Shibl R, Banu S, McPhail SM, Warren J. Three Es of linked injury data: Episodes, Encounters and Events. Inj Prev 2021; 27:479-489. [PMID: 33910970 DOI: 10.1136/injuryprev-2020-044098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Treatment and recovery times following injury can be lengthy, comprising multiple interactions with the hospital system for initial acute care, subsequent rehabilitation and possible re-presentation due to complications. AIMS This article aims to promote the use of consistent terminology in injury data linkage studies, suggest important factors to consider when managing linked injury data, and encourage thorough documentation and a robust discourse around different approaches to data management to ensure reproducibility, consistency and comparability of analyses arising from linked injury data. APPROACH This paper is presented in sections describing: (1) considerations for identifying injury cohorts, (2) considerations for grouping Episodes into Encounters and (3) considerations for grouping Encounters into Events. Summary tools are provided to aid researchers in the management of linked injury data. DISCUSSION Careful consideration of decisions made when identifying injury cohorts and grouping data into units of analysis (Episodes/Encounters/Events) is essential when using linked injury data. Choices made have the potential to significantly impact the epidemiological and clinical findings derived from linked injury data studies, which ultimately affect the quality of injury prevention initiatives and injury management policy and practice. It is intended that this paper will act as a call to action for injury linkage methodologists, and those using linked data, to critique approaches, share tools and engage in a robust discourse to further advance the use of linked injury data, and ultimately enhance the value of linked injury data for clinicians and health and social policymakers.
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Affiliation(s)
- Kirsten Vallmuur
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia .,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Victoria McCreanor
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Cate Cameron
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Angela Watson
- Centre for Accident Research and Road Safety-Queensland, School of Psychology and Counselling, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Rania Shibl
- School of Science Technology and Engineering, University of the Sunshine Coast Engineering and Science, Petrie, Queensland, Australia
| | - Shahera Banu
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,School of Clinical Science, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Steven M McPhail
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Jacelle Warren
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
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McKechnie D, Pryor J, Fisher MJ, Alexander T. A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia. Disabil Rehabil 2019; 42:2718-2725. [PMID: 30763519 DOI: 10.1080/09638288.2019.1568592] [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] [Indexed: 01/22/2023]
Abstract
Aim: To compare the rehabilitation of patients with brain and spinal cord injury in specialist rehabilitation units and non-specialist rehabilitation units in Australia over a 10-year period.Method: A retrospective cohort study design was used. Epidemiological descriptive analysis was used to examine inpatient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database at four discrete time points: 2007, 2010, 2013 and 2016. Data sets included patient demographics, length of stay and the Functional Independence Measure. Data sets were examined for differences between specialist and non-specialist rehabilitation units.Results: Over the 10-year study period, compared to patients admitted to non-specialist rehabilitation units patients admitted to specialist rehabilitation units: (1) were younger and more likely to be male; (2) had a longer time between onset of illness/injury and rehabilitation admission; (3) had a longer median rehabilitation length of stay; (4) had a higher burden of care on admission to rehabilitation; however (5) had a greater functional gain. Patients in specialist rehabilitation units had a lower relative functional efficiency per day of rehabilitation, but higher percentage of Functional Independence Measure gain. In 2016, 66% of brain injury and 51% of spinal cord injury patients were not rehabilitated in specialist rehabilitation units.Conclusion: There are differences in the characteristics of patients admitted to specialist versus non-specialist rehabilitation units. Patients admitted to specialist rehabilitation units have greater functional gain. A noteworthy proportion of brain and spinal cord injury patients are not being rehabilitated in specialist rehabilitation units, particularly patients with non-traumatic injuries.Implications for rehabilitationPatients with a brain or spinal cord injury rehabilitated in specialist rehabilitation units achieve a greater functional gain than those in non-specialist units.Development of best practice admission guidelines would better enable the right care for the right patient in the right setting at the right time.There is a need for longitudinal examination of patient outcomes to better understand the long-term benefits of being rehabilitated in specialist rehabilitation units compared to non-specialist rehabilitation units.
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Affiliation(s)
| | - Julie Pryor
- Royal Rehab, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Murray J Fisher
- Royal Rehab, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Tara Alexander
- Australasian Rehabilitation Outcomes Centre, Wollongong, Australia
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