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Durr K, Ho M, Lebreton M, Goltz D, Nemnom MJ, Perry J. Evaluating the impact of pre-hospital trauma team activation criteria. CAN J EMERG MED 2023; 25:976-983. [PMID: 37938515 DOI: 10.1007/s43678-023-00604-0] [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: 04/14/2023] [Accepted: 09/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Little evidence exists studying the benefits of pre-hospital trauma team activation. Our study measured the impact of pre-hospital trauma team activation on 24-h survival. Our secondary objectives assessed the effects of pre-hospital trauma team activation on time to emergency procedure, computed tomography, blood transfusion, and critical administration threshold, as well as emergency department length of stay. METHODS We conducted a 40-month health records review on all trauma team activations at The Ottawa Hospital, a Level 1 Trauma Center. Outcomes were compared between pre-hospital and in-hospital trauma team activations. We used logistic and linear regression models to assess outcomes, while controlling for injury severity score, age, systolic blood pressure, and anti-coagulation use. A P value < 0.05 was considered statistically significant. A sensitivity analysis was also used to validate the primary outcome results. RESULTS Of the 1013 trauma team activations occurring during the study period, 762 patients were included. The mean age (41.3 vs. 43.8) and percentage of males (79.4% vs. 77.5%) for pre-hospital activations were similar to their counterparts. Pre-hospital activations did not have a statistically significant effect on 24-h mortality (14.4% vs. 4.5%; P = 0.30). However, pre-hospital activations did demonstrate a statistically significant reduction in time (minutes) to emergency procedure (18.0 vs. 27.0; P < 0.001), computed tomography (37.0 vs 42.0; P = 0.009), and blood transfusion (14.0 vs. 28.0; P < 0.001), as well as emergency department length of stay (101.0 vs. 171.0; P < 0.001). CONCLUSION When controlling for key covariates, pre-hospital trauma team activation did not have a significant effect on 24-h mortality, but did result in a significant reduction in time to emergency procedure, computed tomography, and blood transfusion, as well as emergency department length of stay. Our study demonstrates that pre-hospital trauma team activation can expedite patient intervention and disposition.
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Affiliation(s)
- Kevin Durr
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada.
| | - Michael Ho
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
| | - Mathieu Lebreton
- Division of Trauma, Department of General Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Derek Goltz
- Division of Trauma, Department of General Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Yoo J, Kang BH. Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.Methods: Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.Results: There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), <i>p</i> = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), <i>p</i> < 0.001], major bleed from the liver [3.931 (1.203-12.850), <i>p</i> = 0.023], and blood lactate [1.173 (1.009-1.362), <i>p</i> = 0.037] were identified as risk factors for mortality.Conclusion: Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.
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Goulet ND, Liu H, Petrone P, Islam S, Glinik G, Joseph DK, Baltazar GA. Smartphone application alerts for early trauma team activation: Millennial technology in healthcare. Surgery 2021; 171:511-517. [PMID: 34210527 DOI: 10.1016/j.surg.2021.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Data access through smartphone applications (apps) has reframed procedure and policy in healthcare, but its impact in trauma remains unclear. Citizen is a free app that provides real-time alerts curated from 911 dispatch data. Our primary objective was to determine whether app alerts occurred earlier than recorded times for trauma team activation and emergency department arrival. METHODS Trauma registry entries were extracted from a level one urban trauma center from January 1, 2018 to June 30, 2019 and compared with app metadata from the center catchment area. We matched entries to metadata according to description, date, time, and location then compared metadata timestamps to trauma team activation and emergency department arrival times. We computed percentage of time the app reported traumatic events earlier than trauma team activation or emergency department arrival along with exact binomial 95% confidence interval; median differences between times were presented along with interquartile ranges. RESULTS Of 3,684 trauma registry entries, 209 (5.7%) matched app metadata. App alerts were earlier for 96.1% and 96.2% of trauma team activation and emergency department arrival times, respectively, with events reported median 36 (24-53, IQR) minutes earlier than trauma team activation and 32 (25-42, IQR) minutes earlier than emergency department arrival. Registry entries for younger males, motor vehicle-related injuries and penetrating traumas were more likely to match alerts (P < .0001). CONCLUSION Apps like Citizen may provide earlier notification of traumatic events and therefore earlier mobilization of trauma service resources. Earlier notification may translate into improved patient outcomes. Additional studies into the benefit of apps for trauma care are warranted.
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Affiliation(s)
- Nicole D Goulet
- NYU Langone Hospital-Brooklyn, Brooklyn, NY. https://twitter.com/nikkiskier
| | - Helen Liu
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY. https://twitter.com/helenhliu
| | - Patrizio Petrone
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY
| | - Shahidul Islam
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY. https://twitter.com/Shah_Biostat
| | | | - D'Andrea K Joseph
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY. https://twitter.com/ddeekjos
| | - Gerard A Baltazar
- NYU Long Island School of Medicine, Mineola, NY; NYU Langone Hospital-Long Island, Mineola, NY.
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Herath M, Bautz P, Parker D, Dobbins C. The importance of wearing a seatbelt correctly - A case report of blunt trauma causing complete shearing transection of the gastroduodenal junction. Int J Surg Case Rep 2020; 72:197-201. [PMID: 32544828 PMCID: PMC7298554 DOI: 10.1016/j.ijscr.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Seat belt related injuries can cause significant morbidity and mortality in road traffic accidents. We present a case where an improperly worn seatbelt caused traumatic shearing transection of the gastroduodenal junction. A systematic multidisciplinary assessment approach enabled all injuries to be identified early. The patient underwent damage control exploratory laparotomy then delayed reconstruction of the alimentary tract.
Introduction Global mortality as a result of road traffic accidents (RTA) has reduced significantly since mandatory implementation of seatbelts. Whilst seatbelt related injury, or “seatbelt syndrome,” is a recognised phenomenon, unrestrained passengers have considerably worse survival outcomes. Improper positioning of seatbelts, as is discussed in the following case, can cause extensive injury. Presentation of case Our patient is a 35-year-old female who was a restrained front seat passenger in a car vs. tree collision at 80 km/h. Her seat belt was worn with the shoulder strap under her left axilla. She sustained multiple injuries including complete transection of the gastroduodenal junction. In addition to this she had splenic, liver, transverse colonic, left lower rib and humeral injury. She underwent damage control laparotomy with splenectomy; re-look with gastrojejunostomy and transverse colonic resection with defunctioning ileostomy. She made a good recovery and was discharged after a 4 week admission. Discussion Improperly worn seatbelts redistribute decelerative forces to sensitive regions. A multidisciplinary approach is required to effectively manage complex multi-system trauma. In trauma the simplest reconstructive measures can be the most effective and minimise risk of further complications for the patient. Conclusion Improperly worn seatbelts pose a significant risk to patients. A traumatic complete gastroduodenal transection can be effectively reconstructed with gastrojejunostomy anastomosis.
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Affiliation(s)
- Matheesha Herath
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia.
| | - Peter Bautz
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
| | - Dominic Parker
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
| | - Christopher Dobbins
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
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Verhoeff K, Saybel R, Fawcett V, Tsang B, Mathura P, Widder S. A quality-improvement approach to effective trauma team activation. Can J Surg 2020; 62:305-314. [PMID: 31364348 DOI: 10.1503/cjs.000218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Appropriate, timely trauma team activation (TTA) can directly affect outcomes for patients with trauma. A review of quality-performance indicators at our Canadian level 1 trauma centre showed a high level of undertriage, with TTA compliance rates less than 60% for major trauma. A quality-improvement project was undertaken, targeting a sustained goal of at least 90% TTA compliance based on Accreditation Canada guidelines. Methods Quality-improvement action followed a well-defined process. Baseline data collection was performed, and, in keeping with the Donabedian approach, we brought together stakeholders to collectively review and understand the reasons
behind poor TTA compliance; and root-cause analysis. This was followed by rapid change cycles that focused on structure and processes with ongoing audits to support and sustain change. Results Trauma team activation compliance improved from 58.8% to more than 90% over 2 years. Quality indicators showed a statistically significant reduction in the time to computed tomography scanner, time in the acute care region of the emergency department and total time in the emergency department, with improved TTA compliance. Conclusion Compliance with TTA protocols improved to more than 90% over a 2-year period, which shows the benefit of having a clearly outlined qualityimprovement process. This well-defined quality-improvement method provides a framework for use by other institutions that seek to improve their processes of trauma care, including activation rates.
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Affiliation(s)
- Kevin Verhoeff
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Rachelle Saybel
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Vanessa Fawcett
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Bonnie Tsang
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Pamela Mathura
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Sandy Widder
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
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Maliziola C, Frigerio S, Lanzarone S, Barale A, Berardino M, Clari M. Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study. Int Emerg Nurs 2019; 44:20-24. [PMID: 30824337 DOI: 10.1016/j.ienj.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 01/20/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen. OBJECTIVE This study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment. METHODS A retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria. RESULTS Data from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients' death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%. CONCLUSION This study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients' health outcome.
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Affiliation(s)
| | - Simona Frigerio
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Salvatore Lanzarone
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Alessandra Barale
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Maurizio Berardino
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
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Jung K, Heo Y, Lee JCJ, Lee M, Son S, Park HS, Kim JO, Lee JH. Trauma surgery without proper compensation under the current Korean National Health Insurance System. Ann Surg Treat Res 2017; 92:370-375. [PMID: 28480184 PMCID: PMC5416921 DOI: 10.4174/astr.2017.92.5.370] [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: 07/26/2016] [Revised: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries. METHODS We reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings. RESULTS During the study period, total 1,534 trauma surgical procedures were performed for a total of 253 trauma patients. Based on names, 1,092 procedures were performed; however, 442 cases (28.8%) could not be prescribed because of lack of proper insurance codes for the procedures. A total of 1,046.5 surgical procedures were prescribed by surgeons, adjusted by the insurance team, and finally billed to the HIRA; 162 bills were returned from the HIRA after rate reductions, corresponding to a reduction rate of 15.5%. The major reason for reduction was "fee criteria and limited number". The compensation rate for billed surgical procedures was 84.5%. CONCLUSION The high reduction and low compensation rate for trauma surgery under the current Korean National Health Insurance System need to be reviewed and improved. Furthermore, it is necessary to establish new criteria for surgical procedures fees for latest ones such as damage control surgery performed on severe trauma patients.
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Affiliation(s)
- Kyoungwon Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yunjung Heo
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | | | - Mijin Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Suni Son
- Department of Health Insurance, Ajou University Hospital, Suwon, Korea
| | - Hee Suk Park
- Department of Health Insurance, Ajou University Hospital, Suwon, Korea
| | - Joo-Ok Kim
- Department of Health Insurance, Ajou University Hospital, Suwon, Korea
| | - Jeong Hee Lee
- Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea
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