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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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Mehta H, Gheith Z, Amin S, Acharya P, Daon E, Downey P, Hockstad E, Wiley M, Muehlebach G, Zorn G, Danter M, Gupta K. Trends of Hospitalizations and In-Hospital Outcomes for Traumatic Cardiac Injury in United States. Kans J Med 2024; 17:45-50. [PMID: 38859990 PMCID: PMC11164420 DOI: 10.17161/kjm.vol17.21442] [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: 11/09/2023] [Accepted: 04/14/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Traumatic cardiac injury (TCI) poses a significant risk of morbidity and mortality, yet there is a lack of population-based outcomes data for these patients. Methods The authors examined national yearly trends, demographics, and in-hospital outcomes of TCI using the National Inpatient Sample from 2007 to 2014. We focused on adult patients with a primary discharge diagnosis of TCI, categorizing them into blunt (BTCI) and penetrating (PTCI) cardiac injury. Results A total of 11,510 cases of TCI were identified, with 7,155 (62.2%) classified as BTCI and 4,355 (37.8%) as PTCI. BTCI was predominantly caused by motor vehicle collisions (66.7%), while PTCI was mostly caused by piercing injuries (67.4%). The overall mortality rate was 11.3%, significantly higher in PTCI compared to BTCI (20.3% vs. 5.9%, χ2(1, N = 11,185) = 94.9, p <0.001). Additionally, 21.5% required blood transfusion, 19.6% developed hemopericardium, and 15.9% suffered from respiratory failure. Procedures such as heart and pericardial repair were more common in PTCI patients. Length of hospitalization and cost of care were also significantly higher for PTCI patients, W(1, N = 11,015) = 88.9, p <0.001). Conclusions Patients with PTCI experienced higher mortality rates than those with BTCI. Within the PTCI group, young men from minority racial groups and low-income households had poorer outcomes. This highlights the need for early and specialized attention from emergency and cardiothoracic providers for patients in these demographic groups.
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Affiliation(s)
- Harsh Mehta
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Zaid Gheith
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Internal Medicine
| | - Saad Amin
- University of Texas Medical Branch, Galveston, TX
- Department of Internal Medicine
| | - Prakash Acharya
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Emmanuel Daon
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Peter Downey
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Eric Hockstad
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Mark Wiley
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Gregory Muehlebach
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - George Zorn
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Matthew Danter
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Kamal Gupta
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
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Mirzamohamadi S, HajiAbbasi MN, Baigi V, Salamati P, Rahimi-Movaghar V, Zafarghandi M, Isfahani MN, Fakharian E, Saeed-Banadaky SH, Hemmat M, Sadrabad AZ, Daliri S, Pourmasjedi S, Piri SM, Naghdi K, Yazdi SAM. Patterns and outcomes of patients with abdominal injury: a multicenter study from Iran. BMC Emerg Med 2024; 24:91. [PMID: 38816710 PMCID: PMC11141001 DOI: 10.1186/s12873-024-01002-0] [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: 01/15/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI). METHODS This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals. RESULTS Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p < 0.001). Negative laparotomies were 21 (28%) in penetrating trauma and only 11 (7.7%) in blunt group (p < 0.001). In the multiple logistic regression model after adjusting, ISS ≥ 16 increased the chance of ICU admission 3.13 times relative to the ISS 1-8 [OR: 3.13, 95% CI (1.56 to 6.28), P = 0.001]. Another predictor was NOM, which increased ICU chance 1.75 times more than OM [OR: 1.75, 95% CI (1.17 to 2.61), p = 0.006]. Additionally, GCS 3-8 had 5.43 times more ICU admission odds than the GCS 13-15 [OR:5.43, 95%CI (1.81 to 16.25), P = 0.002] respectively. CONCLUSION This study found that the liver and spleen are mostly damaged in blunt injuries. Also, in most cases of penetrating injuries, the colon and small intestine had the highest frequency of injuries compared to other organs. Blunt abdominal injuries caused more blood transfusions and ICU admissions. Higher ISS, lower GCS, and NOM were predictors of ICU admission in abdominal injury victims.
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Affiliation(s)
- Sara Mirzamohamadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | | | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Mohammadreza Zafarghandi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Mehdi Nasr Isfahani
- Trauma Data Registration Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Houssein Saeed-Banadaky
- Trauma Research Center, School of Medicine, Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Akram Zolfaghari Sadrabad
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sobhan Pourmasjedi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Seyed Amir Miratashi Yazdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran.
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Zhang LY, Zhang HY. Torso hemorrhage: noncompressible? never say never. Eur J Med Res 2024; 29:153. [PMID: 38448977 PMCID: PMC10919054 DOI: 10.1186/s40001-024-01760-4] [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: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.
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Affiliation(s)
- Lian-Yang Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Hua-Yu Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Morris ME, Thwaites C, Lui R, McPhail SM, Haines T, Kiegaldie D, Heng H, Shaw L, Hammond S, McKercher JP, Knight M, Carey LM, Gray R, Shorr R, Hill AM. Preventing hospital falls: feasibility of care workforce redesign to optimise patient falls education. Age Ageing 2024; 53:afad250. [PMID: 38275097 PMCID: PMC10811524 DOI: 10.1093/ageing/afad250] [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: 08/02/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission. DESIGN AND SETTING Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet. PARTICIPANTS (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period. OUTCOMES (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility. RESULTS 541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention. CONCLUSIONS It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants.
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Affiliation(s)
- Meg E Morris
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Claire Thwaites
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Rosalie Lui
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Debra Kiegaldie
- Faculty of Health Sciences & Community Studies, Holmesglen Institute, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hazel Heng
- Northern Health Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, VIC, Australia
- Northern Health, Epping, VIC, Australia
| | - Louise Shaw
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Susan Hammond
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Jonathan P McKercher
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
| | - Matthew Knight
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Leeanne M Carey
- Occupational Therapy, Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Ron Shorr
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Anne-Marie Hill
- School of Allied Health, Western Australian Centre for Health & Ageing, The University of Western Australia, Perth, WA, Australia
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Mitra B, Maiden MJ, Read D, Nehme Z, Bernard S, Cameron PA. Definitive management of near-hanging at major versus non-major trauma centres. Emerg Med Australas 2023; 35:849-854. [PMID: 37325861 DOI: 10.1111/1742-6723.14257] [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: 02/24/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The Victorian State Trauma System recommends that all major trauma patients receive definitive care at a major trauma service (MTS). The aim of the present study was to assess the outcomes of patients with major trauma after near-hangings who received definitive management at an MTS compared to a non-MTS. METHODS This was a registry-based cohort study of all adult (age ≥16 years) patients with near-hanging included in the Victorian State Trauma Registry from 1 July 2010 to 30 June 2019. Outcomes of interest were death at hospital discharge, time to death and extended Glasgow Outcome Scale (GOSE) score of 5-8 (favourable) at 6 months. RESULTS There were 243 patients included and 134 (55.1%) in-hospital deaths. Among patients presenting to a non-MTS, 24 (16.8%) were transferred to an MTS. There were 59 (47.6%) deaths at an MTS and 75 (63.0%) at a non-MTS (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.32-0.89). However, more patients were managed at a non-MTS after out-of-hospital cardiac arrest (58.8% vs 50.8%) and less patients had serious neck injury (0.8% vs 11.3%). After adjustment for out-of-hospital cardiac arrests and serious neck injury, management at an MTS was not associated with mortality (adjusted OR [aOR] 0.61; 95% CI 0.23-1.65) or favourable GOSE at 6 months (aOR 1.09; 95% CI 0.40-3.03). CONCLUSIONS After major trauma sustained from near-hanging, definitive management at an MTS did not offer a mortality benefit or better functional outcomes. Consistent with current practice, these findings suggest that most near-hanging related major trauma patients could be managed safely at a non-MTS.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Barwon Health, Geelong, Victoria, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Read
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Arbizu-Fernández E, Echarri-Sucunza A, Galbete A, Fortún-Moral M, Belzunegui-Otano T. Epidemiology of severe trauma in Navarra for 10 years: out-of-hospital/ in-hospital deaths and survivors. BMC Emerg Med 2023; 23:54. [PMID: 37226131 DOI: 10.1186/s12873-023-00818-6] [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: 10/03/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Major trauma is a leading cause of death. Due to the difficulties to keep a registry of these cases, few studies include all subjects, because they exclude out-of-hospital deaths. The purpose of this work was to compare the epidemiological profiles of out-of-hospital deaths, in-hospital deaths, and survivors over a 10-year period (2010-2019) of patients who had been treated by Navarre´s Health Service (Spain). METHODS Retrospective longitudinal cohort study using data of patients injured by an external physical force of any intentionality and with a New Injury Severity Score above 15. Hangings, drownings, burns, and chokings were excluded. Intergroup differences of demographic and clinical variables were analysed using the Kruskal Wallis test, chi-squared test, or Fisher´s exact test. RESULTS Data from 2,610 patients were analysed; 624 died out-of-hospital, 439 in-hospital, and 1,547 survived. Trauma incidences remained moderately stable over the 10-year period analysed, with a slight decrease in out-of-hospital deaths and a slight increase in in-hospital deaths. Patients of the out-of-hospital deaths group were younger (50.9 years) in comparison to in-hospital deaths and survivors. Death victims were predominantly male in all study groups. Intergroup differences regarding prior comorbidities and predominant type of injury were observed. CONCLUSIONS There are significant differences among the three study groups. More than half of the deaths occur out-of-hospital and the causative mechanisms differ in each of them. Thus, when designing strategies, preventive measures were considered for each group on a case-by-case basis.
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Affiliation(s)
| | - Alfredo Echarri-Sucunza
- Subdirección de Urgencias de Navarra, Pamplona, Navarre, Spain
- Polytrauma group, Navarrabiomed - Universitary Hospital of Navarre, Public University of Navarre, Health investigation institute of Navarre, Pamplona, Navarre, Spain
| | - Arkaitz Galbete
- Department of Statistics, Computer Science and Mathematics, Public University of Navarra, RICAPPS, Pamplona, IdiSNA, Spain
| | - Mariano Fortún-Moral
- Subdirección de Urgencias de Navarra, Pamplona, Navarre, Spain
- Polytrauma group, Navarrabiomed - Universitary Hospital of Navarre, Public University of Navarre, Health investigation institute of Navarre, Pamplona, Navarre, Spain
| | - Tomas Belzunegui-Otano
- Emergency Department Hospital Universitario de Navarra, Pamplona, Navarre, Spain
- Polytrauma group, Navarrabiomed - Universitary Hospital of Navarre, Public University of Navarre, Health investigation institute of Navarre, Pamplona, Navarre, Spain
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Beaumont-Boileau R, Nadeau A, Tardif PA, Malo C, Emond M, Moore L, Clément J, Mercier E. Performance of a provincial prehospital trauma triage protocol: A retrospective audit. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231156263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Objective To assess the accuracy of a five-step prehospital trauma triage protocol ( Échelle québécoise de triage préhospitalier en traumatologie (EQTPT)) to identify patients requiring urgent and specialized in-hospital trauma care in the Capitale-Nationale region – Québec. Methods The medical records of trauma patients transported by ambulance to one of the five participating emergency departments (EDs) between November 2016 and March 2017 were reviewed. Our primary outcome was the need for one of the following urgent and specialized trauma care: endotracheal intubation in the ED, administration of ≥ 2 blood products in the ED, angioembolization or surgery (excluding single limb surgery) < 24 h and admission to the intensive care unit (ICU) or in-hospital trauma-related death. Results A total of 902 patients were included. The median age was 63 (interquartile range (IQR) 51) and 494 (54.8%) were female. The main trauma mechanism was falls (n = 592), followed by motor vehicle accidents (n = 201). Eighty-two (9.1%) patients required at least one urgent and specialized trauma care. Of those, 44 (53.6%) were identified as requiring transport to a level one trauma centre (steps 1–3), 16 were identified as requiring transport to a centre with a lower level of trauma designation (steps 4–5) while 22 (26.8%) did not meet any of the EQTPT criteria. For steps 1 to 3, the sensitivity was 53.7% (95% confidence interval (CI) 42.9–64.4) and the specificity was 81.7% (95% CI 79.1–84.4) in identifying patients requiring specialized trauma care. Conclusion The EQTPT lacked sensitivity and was poorly specific to identify trauma patients who need specialized in-hospital trauma care.
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Affiliation(s)
- Roxane Beaumont-Boileau
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Alexandra Nadeau
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Pier-Alexandre Tardif
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Christian Malo
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Marcel Emond
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Lynne Moore
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
| | - Julien Clément
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
- Département de Chirurgie, CHU de Québec, Québec, Canada
| | - Eric Mercier
- VITAM – Centre de recherche en santé durable de l’Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval, Québec, Canada
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9
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Hashimoto A, Kawaguchi H, Hashimoto H. Contribution of the Technical Efficiency of Public Health Programs to National Trends and Regional Disparities in Unintentional Childhood Injury in Japan. Front Public Health 2022; 10:913875. [PMID: 35903376 PMCID: PMC9315066 DOI: 10.3389/fpubh.2022.913875] [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: 04/06/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
To achieve the Sustainable Development Goals, strengthening investments in health service inputs has been widely emphasized, but less attention has been paid to tackling variation in the technical efficiency of services. In this study, we estimated the technical efficiency of local public health programs for the prevention of unintentional childhood injury and explored its contribution to national trend changes and regional health disparities in Japan. Efficiency scores were estimated based on the Cobb-Douglas and translog production functions using a true fixed effects model in a stochastic frontier analysis to account for unobserved time-invariant heterogeneity across prefectures. Using public data sources, we compiled panel data from 2001 to 2017 for all 47 prefectures in Japan. We treated disability-adjusted life years (DALYs) as the output, coverage rates of public health programs as inputs, and caregivers' capacity and environmental factors as constraints. To investigate the contribution of efficiency to trend changes and disparities in output, we calculated the predicted DALYs with several measures of inefficiency scores (2001 average, yearly average, and prefecture-year-specific estimates). In the translog model, mean efficiency increased from 0.62 in 2001 to 0.85 in 2017. The efficiency gaps among prefectures narrowed until 2007 and then remained constant until 2017. Holding inefficiency score constant, inputs and constraints contributed to improvements in average DALYs and widened regional gaps. Improved efficiency over the years further contributed to improvements in average DALYs. Efficiency improvement in low-output regions and stagnated improvement in high-output regions offset the trend of widening regional health disparities. Similar results were obtained with the Cobb-Douglas model. Our results demonstrated that assessing the inputs, constraints, output, and technical efficiency of public health programs could provide policy leverage relevant to region-specific conditions and performance to achieve health promotion and equity.
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Affiliation(s)
- Ayumi Hashimoto
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, University of Tokyo, Tokyo, Japan
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10
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Heathcote K, Devlin A, McKie E, Cameron P, Earnest A, Morgan G, Gardiner B, Campbell D, Wullschleger M, Warren J. Rural and urban patterns of severe injuries and hospital mortality in Australia: An analysis of the Australia New Zealand Trauma Registry: 2015-2019. Injury 2022; 53:1893-1903. [PMID: 35369988 DOI: 10.1016/j.injury.2022.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In Australia, people living in rural areas, compared to major cities are at greater risk of poor health. There is much evidence of preventable disparities in trauma outcomes, however research quantifying geographic variations in injuries, pathways to specialised care and patient outcomes is scarce. AIMS (i) To analyse the Australia New Zealand Trauma Registry (ATR) data and report patterns of serious injuries according to rurality of the injury location ii) to examine the relationship between rurality and hospital mortality and iii) to compare ATR death rates with all deaths from similar causes, Australia-wide. METHOD A retrospective cohort study of patients in the ATR from 1st July 2015 to 30th June 2019 was conducted. Descriptive analyses of trauma variables according to rurality was performed. Logistic regression quantified the moderating effect of rurality on trauma variables and hospital mortality. Australian death data on similar injuries were sourced to quantify the additional mortality attributable to severe injury occurring outside Major Trauma Centres (MTCs). RESULTS Compared to major cities, rural patients were younger, more likely to have spinal cord injuries, and sustain traffic-related injuries that are 'off road'. Injuries occurring outside people's homes are more likely. Mortality risk was greater for patients sustaining severe traumatic brain injury (TBI) spinal cord injury (SCI) and head trauma in addition to intentional injuries. Compared to the ATR data, Australian population-wide trauma mortality rates showed diverging trends according to rurality. The ATR only captures 14.1% of all injury deaths occurring in major cities and, respectively, 6.3% and 3.2% of deaths in regional and remote areas. CONCLUSION Compared to major cities, injuries occurring in rural areas of Australia often involve different mechanisms and result in different types of severe injuries. Patients with neurotrauma and intentional injuries who survived to receive definitive care at a MTC were at higher risk of hospital death. To inform prevention strategies and reduce morbidity and mortality associated with rural trauma, improvements to data systems are required that involve data linkage and include information about patient care from pre-hospital providers, regional hospitals and major trauma centres.
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Affiliation(s)
- Katharine Heathcote
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Anna Devlin
- School of Public Health and Preventive Medicine, Monash University, St Kilda, VIC Australia
| | - Emily McKie
- School of Public Health and Preventive Medicine, Monash University, St Kilda, VIC Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, St Kilda, VIC Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, St Kilda, VIC Australia
| | - Geoff Morgan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Ben Gardiner
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia; Trauma Service, Gold Coast University Hospital, Southport, QLD, Australia
| | - Don Campbell
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia; Trauma Service, Gold Coast University Hospital, Southport, QLD, Australia
| | - Martin Wullschleger
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia; Trauma Service, Royal Brisbane Hospital, Brisbane QLD Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD Australia
| | - Jacelle Warren
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD Australia
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11
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Wang PH, Huang CH, Chen IC, Huang EPC, Lien WC, Huang CH. Survival factors in patients of high fall - A 10-year level-I multi-trauma center study. Injury 2022; 53:932-937. [PMID: 34972562 DOI: 10.1016/j.injury.2021.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aims to investigate the characteristics of patients after free falls at the Level-I trauma centers. The factors associated with survival were differentiated. METHODS This retrospective study was conducted at the National Taiwan University Hospital, the Hsin-Chu branch, and the Yun-Lin branch, all accredited as Level-I trauma centers between January 2010 and September 2020. Adult patients with falls from height of more than one story (i.e. 3.6 m) were included. Clinical data were obtained from electronic medical records. Odds ratios (OR) were computed with 95% confidence intervals (CIs) for significant parameters for survival. RESULTS A total of 371 patients were included. Only 2 survived to discharge with poor neurologic outcomes in 101 patients with OHCA. The overall mortality rate was 98% and 11% in patients with and without OHCA. A higher falling height with a one-meter increase (OR, 1.14, 95% CI, 1.10-1.19) was significantly related to OHCA, especially the height over 6 m (OR, 3.07, 95% CI, 1.19-7.94). A higher trauma injury severity score (TRISS) was significantly related to survival among patients without OHCA (OR, 1.07, 95% CI, 1.04-1.11), especially TRISS≧0.945 (OR, 5.21, 95% CI, 1.28-21.24). Patients without severe head/neck injury of Abbreviated Injury Scale (AIS)≧3 (OR, 0.17, 95% CI, 0.07-0.42) were positively associated with survivors among patients without OHCA. CONCLUSION Patients with traumatic OHCA following falls had a high mortality rate of 98% and dismal outcomes, compared with non-traumatic OHCA. Falling heights, especially over 6 m was associated with OHCA. Patients without OHCA had a mortality rate of 11%. Patients with a higher TRISS, especially more than 0.945, or without severe head injury had more chances to survive in the non-OHCA group. The study provided the evidence to guide termination of high futility resuscitation for traumatic OHCA secondary to falls to conserve the clinical resources.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Chung Chen
- Department of Emergency Medicine, Yun-Lin Branch, National Taiwan University Hospital, Yunlin, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsinchu, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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12
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Red Alert: It Is Time to Strengthen the Medical Knowledge of Noncompressible Torso Hemorrhage Among Health-Care Workers. Disaster Med Public Health Prep 2021; 16:2020-2028. [PMID: 34658325 DOI: 10.1017/dmp.2021.273] [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
OBJECTIVE Noncompressible torso hemorrhage (NCTH) is a major challenge in prehospital bleeding control and is associated with high mortality. This study was performed to estimate medical knowledge and the perceived barriers to information acquisition among health-care workers (HCWs) regarding NCTH in China. METHODS A self-administered and validated questionnaire was distributed among 11 WeChat groups consisting of HCWs engaged in trauma, emergency, and disaster rescue. RESULTS A total of 575 HCWs participated in this study. In the knowledge section, the majority (87.1%) denied that successful hemostasis could be obtained by external compression. Regarding attitudes, the vast majority of HCWs exhibited positive attitudes toward the important role of NCTH in reducing prehospital preventable death (90.4%) and enthusiasm for continuous learning (99.7%). For practice, fewer than half of HCWs (45.7%) had heard of NCTH beforehand, only a minority (14.3%) confirmed they had attended relevant continuing education, and 16.3% HCWs had no access to updated medical information. The most predominant barrier to information acquisition was the lack of continuing training (79.8%). CONCLUSIONS Knowledge and practice deficiencies do exist among HCWs. Obstacles to update medical information warrant further attention. Furthermore, education program redesign is also needed.
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13
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Mitra B, Fogarty M, Cameron PA, Smith K, Bernard S, Burke M, Mercier E, Beck B. Cardiovascular and liver disease among pre-hospital trauma deaths: A review of autopsy findings. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408620954087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Pre-existing disease is a common contributor to mortality and morbidity after injury and resuscitation of injured patients are often altered in hospital based on comorbidities. However, this is uncommon in the pre-hospital phase of care where patients are managed according to clinical practice guidelines. This study aimed to quantify the prevalence of cardiovascular disease (CVD) and liver disease among trauma patients attended by pre-hospital clinicians but who died prior to reaching hospital and assess associations with age. Methods This was a retrospective review of pre-hospital trauma deaths in the state of Victoria, Australia between 01 Jan 2008 and 31 Dec 2014. The inclusion criteria were (a) patients attended by pre-hospital clinicians, (b) deceased before arrival to hospital, (c) evidence of recent trauma and (d) underwent a full autopsy. Cardiovascular and liver disease status were extracted from autopsy reports. Results There were 1043 patients included in this study. Most patients were male (77.1%). Intentional self-harm was significantly more common in patients aged ≥65 years (17.4%). CVD was prevalent in 495 (47.5%; 95%CI: 44.4–50.5) cases with myocardial fibrosis the most common abnormality detected. All sub-groups of CVD demonstrated a significant association with increasing age, except right ventricular hypertrophy. Liver disease was present in 235 (22.5%; 95%CI: 20.1-25.2) patients and most common among patients aged 35–64 years. Discussion CVD was prevalent in almost half of all injured patients included in this study while liver disease was present in about a fifth. The prevalence of CVD was associated with increasing age, while liver disease was more common among middle-aged patients. This high prevalence in our population indicates that pre-existing cardiovascular and liver disease be considered when tailoring pre-hospital life-saving interventions for injured patients.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fogarty
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Steve Bernard
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Michael Burke
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Eric Mercier
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Axis, Université Laval, Quebec City, Québec, Canada
- Département de Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Université Laval, Quebec City, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de Université Laval, Quebec City, Québec, Canada
| | - Ben Beck
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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14
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Davie G, Lilley R, de Graaf B, Ameratunga S, Dicker B, Civil I, Reid P, Branas C, Kool B. Access to specialist hospital care and injury survivability: identifying opportunities through an observational study of prehospital trauma fatalities. Injury 2021; 52:2863-2870. [PMID: 33771346 DOI: 10.1016/j.injury.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Of the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored. OBJECTIVE To determine the number and distribution of prehospital (on-scene/en route) trauma deaths without timely access to a hospital with surgical and intensive care capabilities, overall and by estimated injury survivability. METHODS New Zealand's Mortality Collection and Hospital Discharge dataset were used to select prehospital injury deaths in 2009-2012. These records were linked to files held by Australasia's National Coronial Information Service (NCIS) to estimate, for the trauma subset, injury survivability. Using geographical locations of injury for the prehospital trauma fatalities, time from Emergency Medical System call-out to arrival at the closest specialist hospital was estimated. RESULTS Of 1,752 prehospital trauma fatalities, 14.7% (95%CI 13.0, 16.4) had potentially survivable injuries that occurred in locations without timely access (prehospital phase >60 minutes). More than half (132 of 257) of the potentially survivable prehospital trauma fatalities without timely access died as a result of a motor vehicle traffic crash. Only 10% (95%CI 5.7, 16.0) of prehospital trauma fatalities from falls were estimated to be potentially survivable and without timely access compared to 24.6% (95%CI 18.5, 31.5) of prehospital firearm fatalities. Through using geospatial techniques, "hot spot" locations of potentially survivable injuries without timely access to specialist major trauma hospitals were apparent. CONCLUSION Approximately 15% of prehospital trauma fatalities in New Zealand that are potentially survivable occur in locations without timely access to advanced level hospital care. Continued emphasis is required on both improving timely access to advanced trauma care, and on primary prevention of serious injuries. Decisions regarding trauma service delivery, a modifiable system-level factor, should consider the geographic distribution of locations of these injury events alongside the resident population distribution.
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Affiliation(s)
- Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Shanthi Ameratunga
- Population Health Directorate, Counties Manukau Health, Auckland, New Zealand
| | - Bridget Dicker
- St John, Mt Wellington, Auckland, New Zealand; Department of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ian Civil
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
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15
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Impact of anticoagulation and antiplatelet drugs on surgery rates and mortality in trauma patients. Sci Rep 2021; 11:15172. [PMID: 34312424 PMCID: PMC8313576 DOI: 10.1038/s41598-021-94675-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/08/2021] [Indexed: 01/20/2023] Open
Abstract
Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. We aimed to evaluated the influence of preinjury anticoagulant medication on the clinical course after moderate and severe trauma. Patients in the TraumaRegister DGU ≥ 55 years who received AT were matched with patients not receiving AT. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). The primary end points were early (< 24 h) and total in-hospital mortality. Secondary endpoints included emergency surgical procedure rates and surgery rates. The APD group matched 1759 pairs, the VKA group 677 pairs, and the DOAC group 437 pairs. Surgery rates were statistically significant higher in the AT groups compared to controls (APD group: 51.8% vs. 47.8%, p = 0.015; VKA group: 52.4% vs. 44.8%, p = 0.005; DOAC group: 52.6% vs. 41.0%, p = 0.001). Patients on VKA had higher total in-hospital mortality (23.9% vs. 19.5%, p = 0.026), whereas APD patients showed a significantly higher early mortality compared to controls (5.3% vs. 3.5%, p = 0.011). Standard operating procedures should be developed to avoid lethal under-triage. Further studies should focus on detailed information about complications, secondary surgical procedures and preventable risk factors in relation to mortality.
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16
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Visvanathan R, Ranasinghe DC, Lange K, Wilson A, Dollard J, Boyle E, Jones K, Chesser M, Ingram K, Hoskins S, Pham C, Karnon J, Hill KD. Effectiveness of the Wearable Sensor based Ambient Intelligent Geriatric Management System (AmbIGeM) in Preventing Falls in Older People in Hospitals. J Gerontol A Biol Sci Med Sci 2021; 77:155-163. [PMID: 34153102 PMCID: PMC8751806 DOI: 10.1093/gerona/glab174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background The Ambient Intelligent Geriatric Management (AmbIGeM) system augments best practice and involves a novel wearable sensor (accelerometer and gyroscope) worn by patients where the data captured by the sensor are interpreted by algorithms to trigger alerts on clinician handheld mobile devices when risk movements are detected. Methods A 3-cluster stepped-wedge pragmatic trial investigating the effect on the primary outcome of falls rate and secondary outcome of injurious fall and proportion of fallers. Three wards across 2 states were included. Patients aged ≥65 years were eligible. Patients requiring palliative care were excluded. The trial was registered with the Australia and New Zealand Clinical Trials registry, number 12617000981325. Results A total of 4924 older patients were admitted to the study wards with 1076 excluded and 3240 (1995 control, 1245 intervention) enrolled. The median proportion of study duration with valid readings per patient was 49% ((interquartile range [IQR] 25%-67%)). There was no significant difference between intervention and control relating to the falls rate (adjusted rate ratio = 1.41, 95% confidence interval [0.85, 2.34]; p = .192), proportion of fallers (odds ratio = 1.54, 95% confidence interval [0.91, 2.61]; p = .105), and injurious falls rate (adjusted rate ratio = 0.90, 95% confidence interval [0.38, 2.14]; p = .807). In a post hoc analysis, falls and injurious falls rate were reduced in the Geriatric Evaluation and Management Unit wards when the intervention period was compared to the control period. Conclusions The AmbIGeM system did not reduce the rate of falls, rate of injurious falls, or proportion of fallers. There remains a case for further exploration and refinement of this technology given the post hoc analysis findings with the Geriatric Evaluation and Management Unit wards. Clinical Trials Registration Number: 12617000981325
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Affiliation(s)
- Renuka Visvanathan
- Aged & Extended Care Services and Basil Hetzel Institute, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, Australia
| | | | - Kylie Lange
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Australia
| | - Anne Wilson
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, SA, Australia.,School of Medicine, Flinders University of South Australia, Bedford Park, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Katherine Jones
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Michael Chesser
- School of Computer Science, University of Adelaide, Adelaide, SA, Australia
| | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Stephen Hoskins
- Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Clarabelle Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Rehabilitation, Ageing and Independent Living and mi(RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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17
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Mitra B, Bernard S, Gantner D, Burns B, Reade MC, Murray L, Trapani T, Pitt V, McArthur C, Forbes A, Maegele M, Gruen RL. Protocol for a multicentre prehospital randomised controlled trial investigating tranexamic acid in severe trauma: the PATCH-Trauma trial. BMJ Open 2021; 11:e046522. [PMID: 33722875 PMCID: PMC7970250 DOI: 10.1136/bmjopen-2020-046522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Haemorrhage causes most preventable prehospital trauma deaths and about a third of in-hospital trauma deaths. Tranexamic acid (TXA), administered soon after hospital arrival in certain trauma systems, is an effective therapy in preventing or managing acute traumatic coagulopathy. However, delayed administration of TXA appears to be ineffective or harmful. The effectiveness of prehospital TXA, incidence of thrombotic complications, benefit versus risk in advanced trauma systems and the mechanism of benefit remain uncertain. METHODS AND ANALYSIS The Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (The PATCH-Trauma study) is comparing TXA, initiated prehospital and continued in hospital over 8 hours, with placebo in patients with severe trauma at risk of acute traumatic coagulopathy. We present the trial protocol and an overview of the statistical analysis plan. There will be 1316 patients recruited by prehospital clinicians in Australia, New Zealand and Germany. The primary outcome will be the eight-level Glasgow Outcome Scale Extended (GOSE) at 6 months after injury, dichotomised to favourable (GOSE 5-8) and unfavourable (GOSE 1-4) outcomes, analysed using an intention-to-treat (ITT) approach. Secondary outcomes will include mortality at hospital discharge and at 6 months, blood product usage, quality of life and the incidence of predefined adverse events. ETHICS AND DISSEMINATION The study was approved by The Alfred Hospital Research and Ethics Committee in Victoria and also approved in New South Wales, Queensland, South Australia, Tasmania and the Northern Territory. In New Zealand, Northern A Health and Disability Ethics Committee provided approval. In Germany, Witten/Herdecke University has provided ethics approval. The PATCH-Trauma study aims to provide definitive evidence of the effectiveness of prehospital TXA, when used in conjunction with current advanced trauma care, in improving outcomes after severe injury. TRIAL REGISTRATION NUMBER NCT02187120.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Dashiell Gantner
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney University, Sydney, New South Wales, Australia
| | - Michael C Reade
- Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Lynnette Murray
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Tony Trapani
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Veronica Pitt
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Colin McArthur
- Critical Care Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Marc Maegele
- Cologne Merheim Medical Center, Department of Traumatology, Othopedic Surgery and Sportsmedicine, University of Witten/Herdecke, Cologne, Germany
- Institute for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany
| | - Russell L Gruen
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Carmichael H, Samuels JM, Jamison EC, Bol KA, Coleman JJ, Campion EM, Velopulos CG. Finding the elusive trauma denominator: Feasibility of combining data sets to quantify the true burden of firearm trauma. J Trauma Acute Care Surg 2021; 90:466-470. [PMID: 33105286 DOI: 10.1097/ta.0000000000003005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence guiding firearm injury prevention is limited by current data collection infrastructure. Trauma registries (TR) omit prehospital deaths and underestimate the burden of injury. In contrast, the National Violent Death Reporting System (NVDRS) tracks all firearm deaths including prehospital fatalities, excluding survivors. This is a feasibility study to link these data sets through collaboration with our state public health department, aiming to better estimate the burden of firearm injury and assess comparability of data. METHODS We reviewed all firearm injuries in our Level I TR from 2011 to 2017. We provided the public health department with in-hospital deaths, which they linked to NVDRS using patient identifiers and time of injury/death. The NVDRS collates information about circumstances, incident type, and wounding patterns from multiple sources including death certificates, autopsy records, and legal proceedings. We considered only subjects with injury location in a single urban county to best estimate in-hospital and prehospital mortality. RESULTS Of 168 TR deaths, 166 (99%) matched to NVDRS records. Based on data linkages, we estimate 320 prehospital deaths, 184 in-hospital deaths, and 453 survivors for a total of 957 firearm injuries. For the matched patients, there was near-complete agreement regarding simple demographic variables (e.g., age and sex) and good concordance between incident types (suicide, homicide, etc.). However, agreement in wounding patterns between NVDRS and TR varied. CONCLUSION We demonstrate the feasibility of linking TR and NVDRS data with good concordance for many variables, allowing for good estimation of the trauma denominator. Standardized data collection methods in one data set could improve methods used by the other, for example, training NVDRS abstractors to utilize Abbreviated Injury Scale designations for injury patterns. Such data integration holds immediate promise for guiding prevention strategies. LEVEL OF EVIDENCE Epidemiological study, level IV.
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Affiliation(s)
- Heather Carmichael
- From the University of Colorado (H.C., J.M.S., C.G.V.), Aurora; Colorado Department of Public Health and Environment (E.C.J., K.A.B.), Health Statistics and Evaluation Branch; and Department of Surgery (J.J.C., E.M.C.), Denver Health Medical Center, Denver, Colorado
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Zhang HY, Guo Y, Liu H, Tang H, Li Y, Zhang LY. Imaging Anatomy and Surface Localization of External Control Device-Targeted Arteries for Noncompressible Torso Hemorrhage. Mil Med 2021; 187:e343-e350. [PMID: 33576405 DOI: 10.1093/milmed/usab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND External hemorrhage control devices (EHCDs) are effective in reducing the death risk of noncompressible torso hemorrhage (NCTH), but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on the anatomical features of NCTH-related arteries through CT images to facilitate the optimal design and application of EHCDs. METHODS Two hundred patients who underwent abdominal CT were enrolled. Anatomical parameters such as the length of the common iliac artery (CIA), the external iliac artery (EIA), and the common femoral artery were measured; positional relationships among the EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS), and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by the 3D-printed mannequins of 20 real patients. RESULTS Aortic bifurcation (AB) was 7.5 ± 8.6 mm to the left of the umbilicus. The left CIA (left: 46.6 ± 16.0 mm vs. right: 43.3 ± 15.5 mm, P = .038) and the right EIA (left: 102.6 ± 16.3 mm vs. right: 111.5 ± 18.8 mm, P < .001) were longer than their counterparts, respectively. The vertical distance between the CIA terminus and the ipsilateral AB-ASIS line was 19.6 ± 8.2 mm, and the left and right perpendicular intersections were located at the upper one-third and one-fourth of the AB-ASIS line, respectively. The length ratio of EIA-ASIS to ASIS-PT was 0.6:1. The predicted point and its actual subpoint were significantly correlated (P ≤ .002), and the vertical distance between the two points was ≤5.5 mm. CONCLUSION The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis, and EHCD-related collateral injuries.Trial registration: Ratification no. 2019092. Registered November 4, 2020-retrospectively registered, www.chictr.org.cn.
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Affiliation(s)
- Hua-Yu Zhang
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, Yuzhong 400042, China
| | - Yong Guo
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, Yuzhong 400042, China
| | - Heng Liu
- Department of Radiology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, Yuzhong 400042, China
| | - Hao Tang
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, Yuzhong 400042, China
| | - Yang Li
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, Yuzhong 400042, China
| | - Lian-Yang Zhang
- Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, Yuzhong 400042, China
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20
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Lilley R, Kool B, Davie G, de Graaf B, Dicker B. Opportunities to prevent fatalities due to injury: a cross-sectional comparison of prehospital and in-hospital fatal injury deaths in New Zealand. Aust N Z J Public Health 2021; 45:235-241. [PMID: 33522676 DOI: 10.1111/1753-6405.13068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There is interest in opportunities that lie in the prehospital setting to reduce the substantial burden of fatal injury. This study examines the epidemiology of prehospital and in-hospital fatal injury in New Zealand. METHODS All deaths registered in 2008-2012 with an underlying cause of death external cause-code V01-Y36 (ICD-10-AM) were identified. The setting of death was determined following linkage to, and review of, hospital discharge data and Coronial records. RESULTS Of 7,522 injury deaths, 80% occurred in a prehospital setting, with the highest burden relating to males. Within those fatally injured, 25-54-year-olds had a higher risk of prehospital death than 55-84-year-olds (adjusted Relative Risk [aRR] 1.20, 95%CI 1.16, 1.20). Similarly, those injured due to drowning (aRR 1.39, CI 1.26, 1.53) and non-hanging suffocation (aRR 1.31, CI 1.18, 1.45) had a higher risk of prehospital death than those 'struck by/machinery'. CONCLUSION Prehospital deaths account for four out of five fatal injuries in New Zealand. Of the fatally injured population, the probability of prehospital death differed by age, sex, injury mechanism and intent. Implications for public health: This study highlights the importance of strengthening prevention efforts to reduce the substantive burden of prehospital fatalities in New Zealand.
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Affiliation(s)
- Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Bridget Dicker
- St Johns, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, New Zealand
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21
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O'Brien T, Mitra B, Le Sage N, Tardif PA, Emond M, D'Astous M, Mercier E. Clinically significant traumatic intracranial hemorrhage following minor head trauma in older adults: a retrospective cohort study. Brain Inj 2020; 34:834-839. [PMID: 32286890 DOI: 10.1080/02699052.2020.1753242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The primary objective of this study was to determine the incidence of clinically significant traumatic intracranial hemorrhage (T-ICH) following minor head trauma in older adults. Secondary objective was to investigate the impact of anticoagulant and antiplatelet therapies on T-ICH incidence. METHODS This retrospective cohort study extracted data from electronic patient records. The cohort consisted of patients presenting after a fall and/or head injury and presented to one of five ED between 1st March 2010 and 31st July 2017. Inclusion criteria were age ≥ 65 years old and a minor head trauma defined as an impact to the head without fulfilling criteria for traumatic brain injury. RESULTS From the 1,000 electronic medical records evaluated, 311 cases were included. The mean age was 80.1 (SD 7.9) years. One hundred and eighty-nine (189) patients (60.8%) were on an anticoagulant (n = 69), antiplatelet (n = 130) or both (n = 16). Twenty patients (6.4%) developed a clinically significant T-ICH. Anticoagulation and/or antiplatelets therapies were not associated with an increased risk of clinically significant T-ICH in this cohort (Odds ratio (OR) 2.7, 95% CI 0.9-8.3). CONCLUSIONS In this cohort of older adults presenting to the ED following minor head trauma, the incidence of clinically significant T-ICH was 6.4%.
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Affiliation(s)
- Toby O'Brien
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,National Trauma Research Institute, Alfred Hospital , Melbourne, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Alfred Hospital , Melbourne, Australia.,Canada Département De Médecine Familiale Et Médecine d'Urgence, Faculté De Médecine, Université Laval , Québec, Canada
| | - Natalie Le Sage
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Pier-Alexandre Tardif
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada
| | - Marcel Emond
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval , Quebec, Canada
| | - Myreille D'Astous
- Service of Neurosurgery, Department of Surgery, CHU De Québec, Université Laval , Québec, Canada
| | - Eric Mercier
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval , Quebec, Canada
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22
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Improving the outcomes of injured children: New challenges and opportunities Pediatric Trauma Society Sixth Annual Meeting presidential address. J Trauma Acute Care Surg 2020; 89:607-615. [PMID: 32345896 DOI: 10.1097/ta.0000000000002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Liu JL, Li JY, Jiang P, Jia W, Tian X, Cheng ZY, Zhang YX. Literature review of peripheral vascular trauma: Is the era of intervention coming? Chin J Traumatol 2020; 23:5-9. [PMID: 32014343 PMCID: PMC7049612 DOI: 10.1016/j.cjtee.2019.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/25/2019] [Accepted: 11/25/2019] [Indexed: 02/04/2023] Open
Abstract
Traumatic peripheral vascular injury is a significant cause of disability and death either in civilian environments or on the battlefield. Penetrating trauma and blunt trauma are the most common forms of vascular injuries. Besides, iatrogenic arterial injury (IAI) is another pattern of vascular trauma. The management of peripheral vascular injuries has been improved in different environments and wars. There are different types of vascular injuries, such as vasospasm, contusion, intimal flaps, intimal disruption or hematoma, external compression, laceration, transection and focal wall defects, etc. The main clinical manifestations of vascular injuries are shock following massive hemorrhage and limb necrosis due to tissue and organ ischemia. Ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are most valuable for assessment of peripheral vascular injuries. Angiography remains the gold standard for diagnosing vascular trauma. Immediate hemorrhage control and rapid restoration of blood flow are the primary goals of vascular trauma treatment. There are many operative treatment methods for vascular injuries, such as vascular suture or ligation, vascular wall repair and vascular reconstruction with blood vessel prostheses or vascular grafts. Embolization, balloon dilation and covered stent implantation are the main endovascular techniques. Surgical operation is still the primary treatment for vascular injuries. Endovascular treatment is a promising alternative, proved to be safe and effective, and preferred selection for patients. In summary, rapid diagnosis and timely surgical intervention remain the mainstays of the treatment. However, many issues need to be resolved by further studies.
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Affiliation(s)
- Jian-Long Liu
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
| | - Jin-Yong Li
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Peng Jiang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Jia
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xuan Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Zhi-Yuan Cheng
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yun-Xin Zhang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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