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Garner AA, Suryadevara LSK, Sewalt C, Lane S, Kaur R. The relationship between patient volume and mortality in NSW major trauma service hospitals. Injury 2024; 55:111506. [PMID: 38514287 DOI: 10.1016/j.injury.2024.111506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Conventional wisdom is that Major Trauma Services (MTS) treating larger volumes of severe trauma patients will have better outcomes than lower volume centres, but recent studies from Europe have questioned this relationship. We aimed to determine if there is a relationship between patient volume and outcome in New South Wales (NSW) MTS hospitals. MATERIALS AND METHODS Retrospective observational study using data from the NSW State Trauma Registry from 2010 to 2019 inclusive. Adult patients with Injury Severity Score >15 transported directly to a NSW MTS were included. Outcome measures were mortality at hospital discharge, and intensive care unit and hospital length of stay. Generalised estimating equation models were created to determine the adjusted relationship between patient volume and the main outcome measures. RESULTS The mean annual patient volume of the MTS ranged from 127.4 to 282.0 patients whilst the observed mortality rates p.a. ranged from 10.4 % to 17.19 %. Multivariate analysis, using low volume MTS as the reference, did not demonstrate a significant difference in mortality between high and low volume MTS (adjusted OR: 1.14 95 % CI: 0.98-1.25, P = 0.087). There was however a significant correlation between volume and length of hospital stay (adjusted β; 0.024, 95 % CI, 0.182 - 1.089, P = 0.006). CONCLUSIONS There was no mortality difference between high and low volume MTS demonstrated. Length of hospital stay significantly increased with increasing volume however.
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Affiliation(s)
- Alan A Garner
- Trauma Department, Nepean Hospital, Derby St, Kingswood NSW 2747, Australia; University of Sydney, Nepean Clinical School, Australia.
| | | | - Charlie Sewalt
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stuart Lane
- University of Sydney, Nepean Clinical School, Australia; Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Rajneesh Kaur
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
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Havermans RJM, de Jongh MAC, van der Veen AH, Edwards M, Lansink KWW. Recovery to normal vital functions and acid-base status after a severe trauma in Level I versus Level II Trauma Centres. Eur J Trauma Emerg Surg 2024; 50:513-522. [PMID: 38093136 DOI: 10.1007/s00068-023-02390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/02/2023] [Indexed: 04/23/2024]
Abstract
PURPOSE In the Netherlands, approximately 70% of severely injured patients (ISS ≥ 16) are transported directly to a Level I trauma center. This study compared the time needed to return to normal vital parameters and normal acid-base status in severely injured patients and some in-hospital processes in Level I versus Level II trauma centers. METHODS This retrospective cohort study included all adult severely injured patients or adult trauma patients admitted to the intensive care unit between 2015 and 2020 in a Dutch trauma region. The primary endpoint was time until normal vital parameters and acid-base status. Secondary endpoints were complication rate, hospital length of stay, emergency department length of stay, and time until a computed tomography (CT) scan. RESULTS A total of 2345 patients were included. Patients admitted to a Level I trauma center had a significantly higher rate of normalization of vital parameters over time (HR 1.51). There was no significant difference in normalization rate of the acid-base status over time (HR 1.10). In Level I trauma centers, time spent at the emergency department and time until the CT scan was significantly shorter (respectively, β - 38 min and β - 77 min), and the complication rate was significantly lower (OR 0.35). CONCLUSION Severely injured patients admitted to a Level I trauma center require less time to normalize their vital functions. Level I centers are better equipped, resulting in better in-hospital processes with shorter time at the emergency department and shorter time until a CT scan.
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Affiliation(s)
- Roos J M Havermans
- Department of Surgery, ETZ Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands.
| | - Mariska A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | | | - Michael Edwards
- Department of Trauma Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Koen W W Lansink
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
- Department of Trauma Surgery, ETZ Hospital, Tilburg, The Netherlands
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King KL, Dewar DC, Briggs GD, Jones M, Balogh ZJ. Postinjury multiple organ failure in polytrauma: more frequent and potentially less deadly with less crystalloid. Eur J Trauma Emerg Surg 2024; 50:131-138. [PMID: 36598541 PMCID: PMC10923957 DOI: 10.1007/s00068-022-02202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recently, retrospective registry-based studies have reported the decreasing incidence and increasing mortality of postinjury multiple organ failure (MOF). We aimed to describe the current epidemiology of MOF following the introduction of haemostatic resuscitation. METHODS A 10-year prospective cohort study was undertaken at a Level-1 Trauma Centre-based ending in December 2015. Inclusion criteria age ≥ 16 years, Injury Severity Score (ISS) > 15, Abbreviated Injury Scale (AIS) Head < 3 and survived > 48 h. Demographics, physiological and shock resuscitation parameters were collected. The primary outcome was MOF defined by a Denver Score > 3. SECONDARY OUTCOMES intensive care unit length of stay (ICU LOS), ventilation days and mortality. RESULTS Three hundred and forty-seven patients met inclusion criteria (age 48 ± 20; ISS 30 ± 11, 248 (71%) were males and 23 (6.6%) patients died. The 74 (21%) MOF patients (maximum Denver Score: 5.5 ± 1.8; Duration; 5.6 ± 5.8 days) had higher ISS (32 ± 11 versus 29 ± 11) and were older (54 ± 19 versus 46 ± 20 years) than non-MOF patients. Mean daily Denver scores adjusted for age, sex, MOF and ISS did not change over time. Crystalloid usage decreased over the 10-year period (p value < 0.01) and PRBC increased (p value < 0.01). Baseline cumulative incidence of MOF at 28 days was 9% and competing risk analyses showed that incidence of MOF increased over time (subdistribution hazard ratio 1.14, 95% CI 1.04 to 1.23, p value < 0.01). Mortality risk showed no temporal change. ICU LOS increased over time (subdistribution hazard ratio 0.95, 95% CI 0.92 to 0.98, p value < 0.01). Ventilator days increased over time (subdistribution hazard ratio 0.94, 95% CI 0.9 to 0.97, p value < 0.01). CONCLUSION The epidemiology of MOF continues to evolve. Our prospective cohort suggests an ageing population with increasing incidence of MOF, particularly in males, with little changes in injury or shock parameters, who are being resuscitated with less crystalloids, stay longer on ICU without improvement in survival.
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Affiliation(s)
- Kate L King
- Department of Traumatology, John Hunter Hospital, HRMC, Locked Bag 1, Newcastle, NSW, 2310, Australia
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - David C Dewar
- Department of Traumatology, John Hunter Hospital, HRMC, Locked Bag 1, Newcastle, NSW, 2310, Australia
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Gabrielle D Briggs
- Department of Traumatology, John Hunter Hospital, HRMC, Locked Bag 1, Newcastle, NSW, 2310, Australia
| | - Mark Jones
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, Newcastle, NSW, 2305, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, HRMC, Locked Bag 1, Newcastle, NSW, 2310, Australia.
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, 2300, Australia.
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Hardy BM, Varghese A, Adams MJ, Enninghorst N, Balogh ZJ. The outcomes of the most severe polytrauma patients: a systematic review of the use of high ISS cutoffs for performance measurement. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02409-3. [PMID: 38108840 DOI: 10.1007/s00068-023-02409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND This systematic review aimed to describe the outcomes of the most severely injured polytrauma patients and identify the consistent Injury Severity Score based definition of utilised for their definition. This could provide a global standard for trauma system benchmarking. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was applied to this review. We searched Medline, Embase, Cochrane Reviews, CINAHL, CENTRAL from inception until July 2022. Case reports were excluded. Studies in all languages that reported the outcomes of adult and paediatric patients with an ISS 40 and above were included. Abstracts were screened by two authors and ties adjudicated by the senior author. RESULTS 7500 abstracts were screened after excluding 13 duplicates. 56 Full texts were reviewed and 37 were excluded. Reported ISS groups varied widely between the years 1986 and 2022. ISS groups reported ranged from 40-75 up to 51-75. Mortality varied between 27 and 100%. The numbers of patients in the highest ISS group ranged between 15 and 1451. CONCLUSIONS There are very few critically injured patients reported during the last 48 years. The most critically injured polytrauma patients still have at least a 50% risk of death. There is no consistent inclusion and exclusion criteria for this high-risk cohort. The current approach to reporting is not suitable for monitoring the epidemiology and outcomes of the critically injured polytrauma patients. LEVEL OF EVIDENCE Level 4-systematic review of level 4 studies.
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Affiliation(s)
- Benjamin M Hardy
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
- University of Newcastle, Newcastle, NSW, Australia
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Adrian Varghese
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
| | - Megan J Adams
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
| | - Natalie Enninghorst
- University of Newcastle, Newcastle, NSW, Australia
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia.
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Ferrah N, Beck B, Ibrahim J, Gabbe B, McLellan MS, Cameron P. Older trauma patients with isolated chest injuries have low rates of complications. Injury 2022; 53:4005-4012. [PMID: 36243582 DOI: 10.1016/j.injury.2022.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/24/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The number of older adults hospitalised for injury is growing rapidly. The population-adjusted incidence of isolated thoracic injuries in older adults is also growing. While some older adults are at high risk of post-traumatic complications, not all older adults will need treatment in a major trauma service (MTS). The aim of this study was to characterise older patients with isolated chest injuries, determine the rates of post-traumatic complications, including respiratory failure and pneumonia, and the factors associated with the risk of developing these complications. PATIENTS AND METHODS This was a retrospective review of patients aged 65 years and over with isolated chest trauma, from January 2007 to June 2017, using data from the Victorian State Trauma Registry. Patient characteristics and rates of complications were compared between patients with 1. isolated rib fractures, and 2. complex chest injury. Multivariable logistic regression was used to identify predictors of respiratory failure, and pneumonia. RESULTS The study population comprised 5401 patients aged 65 years or more, with isolated chest injuries. Two-thirds (65%) of all patients had isolated rib fractures, and 58% of patients (n = 3156) were directly admitted to a non-major trauma centre. Complications were uncommon, with 5.45% of all patients (n = 295) having pneumonia and 3.2% (n = 175) having respiratory failure. Factors associated with increased risk of pneumonia and respiratory failure included advancing age, smoking, chronic obstructive pulmonary disease, congestive heart failure, and more severe and complex chest injury. The adjusted odds of complications were lowest amongst patients not classified as major trauma and receiving definitive treatment in non-MTS. DISCUSSION Our findings suggest that rates of complications in older patients with isolated chest trauma in this study were low, and that there is a large group of patients with isolated, uncomplicated rib fractures, who may not need to be treated in a major trauma centre. Further work should be undertaken to appropriately risk stratify and manage older adults with isolated chest trauma.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia.
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Faculty of Medicine, Laval University, Quebec City, Canada
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, VIC Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Health Data Research UK, Swansea University Medical School, United Kingdom
| | - Ms Susan McLellan
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Emergency and Trauma Centre, The Alfred Hospital, VIC, Australia
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Alqurashi N, Alotaibi A, Bell S, Lecky F, Body R. The diagnostic accuracy of prehospital triage tools in identifying patients with traumatic brain injury: A systematic review. Injury 2022; 53:2060-2068. [PMID: 35190184 DOI: 10.1016/j.injury.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prehospital care providers are usually the first responders for patients with traumatic brain injury (TBI). Early identification of patients with TBI enables them to receive trauma centre care, which improves outcomes. Two recent systematic reviews concluded that prehospital triage tools for undifferentiated major trauma have low accuracy. However, neither review focused specifically on patients with suspected TBI. Therefore, we aimed to systematically review the existing evidence on the diagnostic performance of prehospital triage tools for patients with suspected TBI. METHODS A comprehensive search of the current literature was conducted using Medline, EMBASE, CINAHL Plus and the Cochrane library (inception to 1st June 2021). We also searched Google Scholar, OpenGrey, pre-prints (MedRxiv) and dissertation databases. We included all studies published in English language evaluating the accuracy of prehospital triage tools for TBI. We assessed methodological quality and risk of bias using a modified Quality Assessment of Diagnostic Studies (QUADAS-2) tool. Two reviewers independently performed searches, screened titles and abstracts and undertook methodological quality assessments. Due to the heterogeneity in the population of interest and prehospital triage tools used, a narrative synthesis was undertaken. RESULTS The initial search identified 1787 articles, of which 8 unique eligible studies met the inclusion criteria (5 retrospective, 2 prospective, 1 mixed). Overall, sensitivity of triage tools studied ranged from 19.8% to 87.9% for TBI identification. Specificity ranged from 41.4% to 94.4%. Two decision tools have been validated more than once: HITS-NS (2 studies, sensitivity 28.3-32.6%, specificity 89.1-94.4%) and the Field Triage Decision Scheme (4 studies, sensitivity 19.8-64.5%, specificity 77.4%-93.1%). Existing tools appear to systematically under-triage older patients. CONCLUSION Further efforts are needed to improve and optimise prehospital triage tools. Consideration of additional predictors (e.g., biomarkers, clinical decision aids and paramedic judgement) may be required to improve diagnostic accuracy.
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Affiliation(s)
- Naif Alqurashi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK; Department of Accidents and Trauma, Prince Sultan bin Abdelaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmed Alotaibi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
| | - Steve Bell
- Medical Directorate, North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK.
| | - Fiona Lecky
- University of Sheffield, School of Health and Related Research, Sheffield, UK.
| | - Richard Body
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK; Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK.
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Jang JY, Bae KS, Chang SW, Jung K, Kim DH, Kang BH. Current management and clinical outcomes for patients with haemorrhagic shock due to pelvic fracture in Korean regional trauma centres: A multi-institutional trial. Injury 2022; 53:488-495. [PMID: 34916034 DOI: 10.1016/j.injury.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/28/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the current management and clinical outcomes in patients with hemodynamic instability due to pelvic fracture in three regional trauma centres in Korea. PATIENTS AND METHODS Three regional trauma centres participated in this study, and 157 patients who were admitted between January 2015 and December 2018 were enroled. Clinical data were collected prospectively as part of the Korean trauma data bank and were analysed retrospectively. RESULTS The mean age was 59.3 years, and 107 of 157 (68.2%) were male patients. The most common cause of injury was auto-pedestrian accidents, followed by falls and motor vehicle crashes. The mean admission systolic blood pressure and serum lactate level were 86.7 mmHg and 6.68 mmol/L, respectively. Twenty-four patients (15.3%) had a cardiac arrest in the emergency department (ED). The mean injury severity score was 39.1, and the mean probability of survival (Trauma and Injury Severity Score) was 48.7%. Sixty-six patients (42%) underwent pelvic angiography; 89 (56.7%), preperitoneal pelvic packing (PPP); 27 (17.2%), resuscitative endovascular balloon occlusion of the aorta (REBOA); 20 (12.7%), pelvic external fixation (PEF); and 13 patients (8.3%), internal iliac artery ligation (IIAL). Seventy-three patients (46.5%) died, including 40 (25.5%) who died from acute haemorrhage. With each year, the rates of REBOA and pelvic binder use continued to increase (p<0.001 and p = 0.005, respectively), but the number of PEF cases significantly decreased (p = 0.006). Age, initial lactate, low revised trauma score (RTS), combined abdominal injury, REBOA, and 4-hour requirement of packed red blood cells were independent risk factors associated with mortality, whereas during the period of 2017 and 2018, there were protective factors. The risk factors of mortality due to haemorrhage were cardiac arrest in the ED, RTS, combined chest and abdominal injuries, and IIAL. CONCLUSIONS Since the establishment of regional trauma centres, the clinical outcomes of patients with hemodynamic instability due to pelvic fracture have significantly improved. As a haemostatic procedure for these patients, PEF has been used less frequently, while pelvic binder and REBOA showed significant increase in their use.
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Affiliation(s)
- Ji Young Jang
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Keum Seok Bae
- Regional trauma center, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Wook Chang
- Regional trauma center, Dankook University Hospital, Cheonan, Republic of Korea
| | - Kyoungwon Jung
- Regional trauma center, Ajou University Hospital, Suwon, Republic of Korea
| | - Dong Hun Kim
- Regional trauma center, Dankook University Hospital, Cheonan, Republic of Korea.
| | - Byung Hee Kang
- Regional trauma center, Ajou University Hospital, Suwon, Republic of Korea.
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Okoye OG, Olaomi OO, Osi-Ogbu O, Gwaram UA. Pattern of trauma in elderly patients seen at the trauma centre of national hospital Abuja, Nigeria. Afr J Emerg Med 2021; 11:347-51. [PMID: 34367894 DOI: 10.1016/j.afjem.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/30/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The global population is aging, creating challenges for health systems. The mean age of patients with major trauma has increased over time, posing some challenges for trauma system designs. Elderly trauma patients are said to have higher mortality rates and longer hospital and intensive care unit stays. This study is aimed at assessing the pattern of injuries in elderly population in a dedicated trauma centre of a developing economy. Methods This is a retrospective study of all patients aged 60 years and above seen in the trauma centre of a West African tertiary hospital over a three year period from January 2017 to December 2019. Relevant parameters including Sociodemographic data, injury pattern and injury scores were derived from the trauma registry. Data analysis was done using statistical package for social sciences (SPSS) version 24. Results were presented using tables and a figure. Results A total of 183 patients aged 60 years and above were enrolled out of 4549 general trauma patients, representing 4% of the trauma patient population seen. Male to female ratio was 2.3 with the mean age of 65 ± 6.3. The most frequent mechanisms of injury were motor vehicular crash (MVC) (48.4%), followed by falls (16.5%). More proportion of females (21.8%) were significantly found to suffer falls compared to their males (14.2%) counterparts (p < 0.05). Traumatic brain injury was the commonest diagnosis accounting for 24.3% of cases. The predominant revised trauma scores (RTS) and injury severity scores (ISS) were 12 and 1–15 respectively, with overall mortality of 6.1%. Conclusion The proportion of elderly trauma patients studied in this centre is low. MVC is still the leading mechanism of injury in our elderly trauma population. The mortality rate is however low in this study, in line with the low trauma and severity scores. Preventive measures for MVC should be strongly encouraged to reduce the incidence of elderly trauma patients in this part of the world.
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Alharbi RJ, Shrestha S, Lewis V, Miller C. The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis. World J Emerg Surg 2021; 16:38. [PMID: 34256793 PMCID: PMC8278750 DOI: 10.1186/s13017-021-00381-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development. METHOD A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI). RESULTS A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001). CONCLUSION The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019142842 .
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Affiliation(s)
- Rayan Jafnan Alharbi
- School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, Bundoora, VIC, 3086, Australia. .,Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia.
| | - Sumina Shrestha
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.,Community Development and Environment Conservation Forum, Chautara, Nepal
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Charne Miller
- School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, Bundoora, VIC, 3086, Australia
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Hung KKC, Rainer TH, Yeung JHH, Cheung C, Leung Y, Leung LY, Chong M, Ho HF, Tsui KL, Cheung NK, Graham C. Seven-year excess mortality, functional outcome and health status after trauma in Hong Kong. Eur J Trauma Emerg Surg 2021; 48:1417-1426. [PMID: 34086062 DOI: 10.1007/s00068-021-01714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose was to investigate long-term health impacts of trauma and the aim was to describe the functional outcome and health status up to 7 years after trauma. METHODS We conducted a prospective, multi-centre cohort study of adult trauma patients admitted to three regional trauma centres with moderate or major trauma (ISS ≥ 9) in Hong Kong (HK). Patients were followed up at regular time points (1, 6 months and 1, 2, 3, 4, 5, 6, and 7 years) by telephone using extended Glasgow Outcome Scale (GOSE) and the Short-Form 36 (SF36). Observed annual mortality rate was compared with the expected mortality rate estimated using the HK population cohort. Linear mixed model (LMM) analyses examined the changes in SF36 with subgroups of age ≥ 65 years, ISS > 15, and GOSE ≥ 5 over time. RESULTS At 7 years, 115 patients had died and 48% (138/285) of the survivors responded. The annual mortality rate (AMR) of the trauma cohort was consistently higher than the expected mortality rate from the general population. Forty-one percent of respondents had upper good recovery (GOSE = 8) at 7 years. Seven-year mean PCS and MCS were 45.06 and 52.06, respectively. LMM showed PCS improved over time in patients aged < 65 years and with baseline GOSE ≥ 5, and the MCS improved over time with baseline GOSE ≥ 5. Higher mortality rate, limited functional recovery and worse physical health status persisted up to 7 years post-injury. CONCLUSION Long-term mortality and morbidity should be monitored for Asian trauma centre patients to understand the impact of trauma beyond hospital discharge.
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Affiliation(s)
- Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Emergency Medicine Unit, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Janice Hiu Hung Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Catherine Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yuki Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Marc Chong
- School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hiu Fai Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Kwok Leung Tsui
- Trauma Committee, New Territory West Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Nai Kwong Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Colin Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. .,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong.
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11
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Hung KCK, Lai CY, Yeung JHH, Maegele M, Chan PSL, Leung M, Wong HT, Wong JKS, Leung LY, Chong M, Cheng CH, Cheung NK, Graham CA. RISC II is superior to TRISS in predicting 30-day mortality in blunt major trauma patients in Hong Kong. Eur J Trauma Emerg Surg 2021; 48:1093-1100. [PMID: 33900416 DOI: 10.1007/s00068-021-01667-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Hong Kong (HK) trauma registries have been using the Trauma and Injury Severity Score (TRISS) for audit and benchmarking since their introduction in 2000. We compare the mortality prediction model using TRISS and Revised Injury Severity Classification, version II (RISC II) for trauma centre patients in HK. METHODS This was a retrospective cohort study with all five trauma centres in HK. Adult trauma patients with Injury Severity Score (ISS) > 15 suffering from blunt injuries from January 2013 to December 2015 were included. TRISS models using the US and local coefficients were compared with the RISC II model. The primary outcome was 30-day mortality and the area under the receiver operating characteristic curve (AUC) for tested models. RESULTS 1840 patients were included, of whom 1236/1840 (67%) were male. Median age was 59 years and median ISS was 25. Low falls were the most common mechanism of injury. The 30-day mortality was 23%. RISC II yielded a superior AUC of 0.896, compared with the TRISS models (MTOS: 0.848; PATOS: 0.839; HK: 0.858). Prespecified subgroup analyses showed that all the models performed worse for age ≥ 70, ASA ≥ III, and low falls. RISC II had a higher AUC compared with the TRISS models in all subgroups, although not statistically significant. CONCLUSION RISC II was superior to TRISS in predicting the 30-day mortality for Hong Kong adult blunt major trauma patients. RISC II may be useful when performing future audit or benchmarking exercises for trauma in Hong Kong.
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Affiliation(s)
- Kei Ching Kevin Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.,Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - Chun Yu Lai
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.,Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - Janice Hiu Hung Yeung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.,Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - Marc Maegele
- Cologne-Merheim Medical Center (CMMC), Department of Trauma and Orthopedic Surgery, University Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany
| | - Po Shan Lily Chan
- Trauma Service, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Ming Leung
- Department of Surgery, Princess Margaret Hospital, 2‑10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Hay Tai Wong
- Trauma Service, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong Island, Hong Kong
| | - John Kit Shing Wong
- Trauma Service, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Marc Chong
- School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Hung Cheng
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.,Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - Nai Kwong Cheung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong.,Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - Colin Alexander Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong. .,Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong.
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12
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Kippnich M, Schorscher N, Kredel M, Markus C, Eden L, Gassenmaier T, Lock J, Wurmb T. Dual-room twin-CT scanner in multiple trauma care: first results after implementation in a level one trauma centre. Eur J Trauma Emerg Surg 2020; 47:1847-1852. [PMID: 32335685 PMCID: PMC7223892 DOI: 10.1007/s00068-020-01374-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
Abstract
Purpose The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator. Methods All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained. Results 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9–34) (median and interquartile range, IQR). tCT was 15 (11–19) minutes (median and IQR) and tOR was 96.5 (75–119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1–6) (median and IQR) and one (0–1) (median and IQR) ventilator day. Conclusion The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously.
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Affiliation(s)
- Maximilian Kippnich
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany.
| | - Nora Schorscher
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany
| | - Markus Kredel
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Würzburg, Germany
| | - Christian Markus
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Würzburg, Germany
| | - Lars Eden
- Department of Trauma Surgery, University Hospital of Wuerzburg, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Johann Lock
- Department of General and Visceral Surgery, University Hospital of Wuerzburg, Würzburg, Germany
| | - Thomas Wurmb
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany
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13
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Gabbe BJ, Veitch W, Curtis K, Martin K, Gomez D, Civil I, Moran C, Teague WJ, Holland AJ, Lecky F, Fitzgerald M, Nathens A, Joseph A. Survey of major trauma centre preparedness for mass casualty incidents in Australia, Canada, England and New Zealand. EClinicalMedicine 2020; 21:100322. [PMID: 32382716 PMCID: PMC7201027 DOI: 10.1016/j.eclinm.2020.100322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mass casualty incidents (MCIs) are increasing. Trauma centres play a key role in MCIs due to their readiness and expansive multidisciplinary expertise for injury management. Previous studies have shown deficiencies in trauma centre disaster preparedness. The aim of this study was to describe the current disaster preparedness of Major Trauma Centres (MTCs) in Australia, Canada, England and New Zealand. METHODS A cross-sectional survey of all (n = 82) MTCs was undertaken. The anonymous survey collected data about disaster preparedness in nine key areas. Respondents were encouraged to consult appropriately at their centre to provide an accurate representation of their centre's preparedness. FINDINGS Responses were received from 69 (84%) centres; 61 completed all questions. 91% had a disaster preparedness committee and 80% had an all-hazards emergency plan. 79% had held an MCI drill in the past 2 years. 54% reported a system in place to calculate maximum capacity, but testing of surge capacity was uncommon. 55% reported the presence of stored resources for an MCI and 58% had a database of staff trained in Emergency Management. 74% had a training and education plan available for staff involved in an MCI and a plan for professional debriefing of staff post-MCI, while 62% had a post-disaster employee assistance programme. Most centres had appropriate back-up communication, safety and security plans. INTERPRETATION The disaster preparedness of MTCs was high for communication, safety and security but there was clear need for improvement in other areas including surge capacity, human resources and post-disaster recovery.
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Affiliation(s)
- Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
- Corresponding author.
| | - William Veitch
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Kate Curtis
- School of Medicine, University of Sydney, Edward Ford Building (A27) Fisher Road, University of Sydney, Sydney 2006, Australia
- Susan Wakil School of Nursing and Midwifery, University of Sydney, 88 Mallett St, Camperdown 2050, Australia
| | - Kate Martin
- Trauma Service, The Alfred, 55 Commercial Rd, Melbourne 3004, Australia
| | - David Gomez
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond St, Toronto M5B 1W8, ON, Canada
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton 1023, Auckland, New Zealand
| | - Chris Moran
- Department of Trauma and Orthopaedics, Nottingham University Hospital, Hucknall Rd, Nottingham NG5 1 PB, United Kingdom
| | - Warwick J. Teague
- Trauma Service, The Royal Children's Hospital, 50 Flemington Rd, Parkville 3052, Australia
- Surgical Research, Murdoch Children's Research Institute, Flemington Rd, Parkville 3052, Australia
- Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville 3052, Australia
| | - Andrew J.A. Holland
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Faculty of Medicine and Health, Westmead 2145, Australia
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, University of Sheffield, Western Bank S10 2TN, Sheffield, , United Kingdom
| | - Mark Fitzgerald
- Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne 3004, Australia
| | - Avery Nathens
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto M4N 3M5, ON, Canada
| | - Anthony Joseph
- Royal North Shore Hospital Clinical School, School of Medicine, University of Sydney, Kolling Building Level 7, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia
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14
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Birindelli A, Podda M, Segalini E, Cripps M, Tonini V, Tugnoli G, Lim RB, Di Saverio S. Is the minimally invasive trauma surgeon the next (r)evolution of trauma surgery? Indications and outcomes of diagnostic and therapeutic trauma laparoscopy in a level 1 trauma centre. Updates Surg 2020; 72:503-512. [PMID: 32219731 DOI: 10.1007/s13304-020-00739-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/04/2020] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the trend in use, feasibility and safety of laparoscopy in a single level 1 European trauma centre. Laparoscopy in abdominal trauma is gaining acceptance as a diagnostic and a therapeutic tool as it reduces surgical invasiveness and may reduce post-operative morbidity. All trauma patients who underwent a laparoscopic procedure between January 2013 and December 2017 were retrospectively analysed. A sub-analysis of isolated abdominal trauma was also performed. There has been a significant increase in the use of this technique in the considered time period. A total of 40 patients were included in the study: 17 diagnostic laparoscopies and overall 32 therapeutic laparoscopies. Conversion rate was 15%. All patients were hemodynamically stable. The majority of patients were younger than 60 years, with an ASA score of I-II and sustained a blunt trauma. Mean ISS score was 17. Colon and diaphragm were the most commonly laparoscopically diagnosed injuries, while splenectomy was the most common operation. The average operating time was 106 min. There were no missed injuries, no SSI, no re-interventions and no mortality related to the surgical procedure. The average length of stay was 14 days. No significant difference was found in the isolated abdominal trauma group. Laparoscopy is an emergent safe and effective technique for both diagnostic and therapeutic purposes in selected stable abdominal penetrating or blunt trauma patients. However, these results need to be put in relation with the level of the centre and the expertise of the surgeon.
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Affiliation(s)
- Arianna Birindelli
- Department of Surgery, University of Bologna, Bologna, Italy.,General, Trauma and Emergency Surgery Unit, Bufalini Hospital, Cesena, Italy
| | - Mauro Podda
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Michael Cripps
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Valeria Tonini
- Department of Surgery, University of Bologna, Bologna, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Robert B Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, HI, USA
| | - Salomone Di Saverio
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK. .,Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy.
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15
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Beak P, Gabbott B, Williamson M, Hing CB. Four years of experience as a major trauma centre results in no improvement in patient selection for whole-body CT scans following blunt trauma. Eur J Orthop Surg Traumatol 2019; 30:473-477. [PMID: 31705403 DOI: 10.1007/s00590-019-02592-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Management of major trauma patients with evidence of polytrauma involves the use of immediate whole-body CT (WBCT). Identification of patients appropriate for immediate WBCT remains challenging. Our study aimed to assess for improvement in patient selection for WBCT over time as a major trauma centre (MTC). METHODS We conducted a retrospective study of patients who presented to our MTC during distinct two-month periods, one in 2013 and the other in 2017. Patients over 18 years of age who presented primarily following blunt trauma and activated a major trauma call were included. All patients underwent either immediate WBCT or standard ATLS workup. Those undergoing WBCT had the results of their scan recorded as positive or negative. RESULTS A total of 516 patients were included, 232 from 2 months in 2013 and 284 from 2 months in 2017. There was no significant difference in the proportion of patients undergoing WBCT (61.6% vs 59.5%), selective CT (31.9% vs 32.4%) or no CT (6.5% vs 8.1%) between the cohorts. There was no improvement in the rate of negative WBCT observed between 2013 and 2017 (47.6% vs 39.6%, p = 0.17). CONCLUSION There was no improvement in patient selection for WBCT following trauma at our institution over a three-year period. Optimal patient selection presents an ongoing clinical challenge, with 39-47% of patients undergoing a scan demonstrating no injuries.
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Affiliation(s)
- Philip Beak
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Ben Gabbott
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Williamson
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caroline B Hing
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
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16
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Brown E, Tohira H, Bailey P, Fatovich D, Pereira G, Finn J. A comparison of major trauma patient transport destination in metropolitan Perth, Western Australia. Australas Emerg Care 2019; 23:90-96. [PMID: 31668941 DOI: 10.1016/j.auec.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite evidence of a lower risk of death, major trauma patients are not always transported to Trauma Centres. This study examines the characteristics and outcomes of major trauma patients between transport destinations. METHODS A retrospective cohort study of major trauma patients (Injury Severity Score >15) transported by ambulance was undertaken. Cases were divided into transport destination groups: (1) Direct, those transported to the Trauma Centre directly from the scene; (2) Indirect, those transported to another hospital prior to Trauma Centre transfer and (3) Non-transfers, those transported to a non-Trauma Centre and never subsequently transferred. Median and interquartile range (IQR) were used to describe the groups and differences were assessed using the Kruskal-Wallis test for continuous variables and Pearson chi-square for categorical. RESULTS A total of 1625 patients were included. The median age was oldest in the non-transfers cohort (72 years IQR 46-84). This group had the highest proportion of falls from standing and head injuries (n = 298/400, 75%, p < 0.001). The non-transfers had the highest proportion of 30-day mortality (n = 134/400, 34%). CONCLUSIONS There were significant differences between the groups with older adults, falls and head injuries over-represented in the non-transfer group. Considering the ageing population, trauma systems will need to adapt.
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Affiliation(s)
- Elizabeth Brown
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; St John Western Australia, 209 Great Eastern Hwy, Bentley, WA, Australia.
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Division of Emergency Medicine, The University of Western Australia, Bentley, WA, Australia.
| | - Paul Bailey
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; St John Western Australia, 209 Great Eastern Hwy, Bentley, WA, Australia.
| | - Daniel Fatovich
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Emergency Medicine, Royal Perth Hospital, University of Western Australia, Bentley, WA, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, WA, Australia.
| | - Gavin Pereira
- School of Public Health, Curtin University, Bentley, WA, Australia; Telethon Kids Institute, WA, Australia.
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; St John Western Australia, 209 Great Eastern Hwy, Bentley, WA, Australia; Division of Emergency Medicine, The University of Western Australia, Bentley, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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17
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Havermans RJM, de Jongh MAC, Bemelman M, van Driel APG, Noordergraaf GJ, Lansink KWW. Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes. Injury 2019; 50:1678-83. [PMID: 31337494 DOI: 10.1016/j.injury.2019.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The implementation of trauma systems has led to a significant reduction in mortality and length of hospital stay. In our level I trauma centre, 24/7 in-hospital coverage was implemented, and a renovation of the trauma room took place to improve the trauma care. The aim of the present study was to examine the effect of the optimised in-hospital infrastructure in terms of mortality, processes and clinical outcomes. METHODS We performed a retrospective cohort study of prospectively collected data. All adult trauma patients admitted to our trauma centre directly during two time periods (2010-2012 and 2014-2016) were included. Any patients below the age of 18 years and patients who underwent primary trauma screening in another hospital were excluded. Logistic and linear regression were used and adjusted for demographics and characteristics of trauma. The primary endpoint was mortality. The secondary endpoints were subgroups of earlier mortality rates and severely injured patients, processes and clinical outcomes. RESULTS In period I, 1290 patients were included, and in period II, 2421. The adjusted mortality in the trauma room (odds ratio (OR): 0.18; CI: 0.05-0.63) and the total in-hospital mortality (OR: 0.63 CI: 0.42-0.95) showed a significant reduction in period II. The trauma room (TR) time decreased by 30 min (p < 0.001), and the time until CT decreased by 22 min (p < 0.001). The number of delayed diagnoses and complications were significantly lower in the second period, with an OR of 0.2 (CI: 0.1-0.2) and 0.4 (CI: 0.3-0.6), respectively. The hospital length of stay and ICU length of stay decreased significantly, -1.5 day (p = 0.010) and -1.8 days (p = 0.022) respectively. CONCLUSIONS Optimisation of the in-hospital infrastructure related to trauma care resulted in improved survival rates in both severely injured patients as well as in the whole trauma population. Moreover, the processes and clinical outcomes improved, showing a shorter hospital length of stay, shorter TR time, fewer complications and fewer delayed diagnoses.
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18
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Hundersmarck D, Reinders Folmer E, de Borst GJ, Leenen LPH, Vriens PWHE, Hietbrink F. Penetrating Neck Injury in Two Dutch Level 1 Trauma Centres: the Non-Existent Problem. Eur J Vasc Endovasc Surg 2019; 58:455-462. [PMID: 31307866 DOI: 10.1016/j.ejvs.2019.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Penetrating neck injuries (PNIs) have a low incidence in European trauma populations. Selective non-operative management of PNI has been suggested as a safe alternative to standard surgical neck exploration, but evidence is lacking. This clinical scenario evaluates institutional PNI management, specifically the associated carotid artery injury, and compares it with current guidelines. METHODS Retrospectively, PNI patients presenting at two Dutch level 1 trauma centres from 2007 to 2015, were identified. International guidelines on PNI management were reviewed and recommendations were assessed in relation to current institutional management, and considering an illustrative case. RESULTS Two current guidelines on PNI management were reviewed. Both advocate a zone based approach; one recommends a prominent role for computed tomography angiography (CTA) scanning in stable patients, supplemented by endoscopy when indicated. A combined total of 43 PNI patients were identified over a nine year period. Haemodynamically unstable patients and patients with other hard signs (i.e. active bleeding, expanding haematoma, air/saliva leak, massive subcutaneous emphysema) received immediate exploration (n = 9). Haemodynamically stable patients and those responding to resuscitation (transient responders) had a CTA scan (n = 31). Three asymptomatic patients were treated conservatively, and had an uncomplicated clinical course regarding the PNI. In 10 of 14 patients who received surgical exploration, a significant vascular or aerodigestive injury was found and repaired (71%). All patients treated conservatively after CTA scanning had an uncomplicated clinical course regarding the PNI (n = 17). Six patients with penetrating carotid artery injury underwent primary arterial reconstruction, of whom five survived. CONCLUSIONS This clinical scenario evaluates institutional management in two trauma centres for PNI and associated carotid artery injury, and compares it to current guidelines. In comparison with guideline recommendations, CTA scanning and the so called "No zone" approach appears to have assumed a more prominent role in management of PNI.
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Affiliation(s)
- Dennis Hundersmarck
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Falco Hietbrink
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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19
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Maegele M, Galvagno SM. Implementation of trauma systems: Not inventing the wheel over and over again! Anaesth Crit Care Pain Med 2019; 38:107-108. [PMID: 30742928 DOI: 10.1016/j.accpm.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marc Maegele
- Department of Traumatology and Orthopaedic Surgery Cologne-Merheim Medical Centre (CMMC) Institute for Research in Operative Medicine (IFOM) University Witten-Herdecke (UWH) Ostmerheimerstr. 200 D-51109 Köln, Germany.
| | - Samuel M Galvagno
- School of Medicine R Adams Cowley Shock Trauma Center Department of Anesthesiology and Program in Trauma Baltimore, 21201 Baltimore, United States of America.
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20
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Würdemann FS, Smeeing DPJ, Ferree S, Nawijn F, Verleisdonk EJMM, Leenen LPH, Houwert RM, Hietbrink F. Differentiation in an inclusive trauma system: allocation of lower extremity fractures. World J Emerg Surg 2018; 13:18. [PMID: 29682003 PMCID: PMC5899363 DOI: 10.1186/s13017-018-0178-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background Implementation of an inclusive trauma system leads to reduced mortality rates, specifically in polytrauma patients. Field triage is essential in this mortality reduction. Triage systems are developed to identify patients with life-threatening injuries, and trauma mechanisms are important for triaging. Although complex extremity fractures are mostly non-lethal, these injuries are frequently the result of a high-energy trauma mechanism. The aim of this study is to compare injury and patient characteristics, as well as resource demands, of lower extremity fractures between a level (L)1 and level (L)2 trauma centre in a mature inclusive trauma system. Methods This is a retrospective cohort study. Patients with below-the-knee joint fractures diagnosed in a L1 or L2 trauma centre between July 2013 and June 2015 were included. Main outcome parameters were patient demographics, trauma mechanism, fracture pattern, and resource demands. Results One thousand two hundred sixty-seven patients with 1517 lower extremity fractures were included. Most patients were treated in the L2 centre (L1 = 417; L2 = 859). Complex fractures were more frequently triaged to the L1 centre. Patients in the L1 centre had more concomitant injuries to other body regions and ipsi- or contralateral lower extremity. Patients in the L1 centre were more resource demanding: more surgeries (> 1 surgery; 24.9% L1 vs 1.4% L2), higher immediate admission rates (70.1% L1 vs 37.6% L2), and longer length of stay (mean 13.4 days L1 vs 3.1 days L2). Conclusion The majority of patients were treated in the L2 trauma centre, whereas complex lower extremity injuries were mostly treated in the L1 centre, which placed higher demand on resources and labour per patient. This change in allocation is the next step in centralization of low-volume high complex care and high-volume low complex care.
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Affiliation(s)
- F S Würdemann
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.,3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D P J Smeeing
- 2Traumacenter, University Medical Center Utrecht, Utrecht, The Netherlands.,3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - S Ferree
- 3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - F Nawijn
- 3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - L P H Leenen
- 3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - R M Houwert
- 2Traumacenter, University Medical Center Utrecht, Utrecht, The Netherlands.,3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - F Hietbrink
- 3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Gotlib Conn L, Zwaiman A, DasGupta T, Hales B, Watamaniuk A, Nathens AB. Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres. Injury 2018; 49:97-103. [PMID: 28988066 DOI: 10.1016/j.injury.2017.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. METHODS A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. RESULTS Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. CONCLUSIONS The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention.
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Zafar SN, Shah AA, Zogg CK, Hashmi ZG, Greene WR, Haut ER, Cornwell EE, Haider AH. Morbidity or mortality? Variations in trauma centres in the rescue of older injured patients. Injury 2016; 47:1091-7. [PMID: 26724172 DOI: 10.1016/j.injury.2015.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prior analysis demonstrates improved survival for older trauma patients (age>64years) treated at trauma centres that manage a higher proportion of geriatric patients. We hypothesised that 'failure to rescue' (death after a complication during an in-hospital stay) may be responsible for part of this variation. The objective of the study was to determine if trauma centre failure to rescue rates are associated with the proportion of older trauma seen. METHODS We analysed data from high volume level 1 and 2 trauma centres participating in the National Trauma Data Bank, years 2007-2011. Centres were categorised by the proportion of older trauma patients seen. Logistic regression analyses were used to provide risk-adjusted rates for major complications (MC) and, separately, for mortality following a MC. Models were adjusted for patient demographics, comorbid conditions, mechanism and type of injury, presenting vital signs, injury severity, and multiple facility-level covariates. Risk-adjusted rates were plotted against the proportion of older trauma seen and trends determined. RESULTS Of the 396,449 older patients at 293 trauma centres that met inclusion criteria, 30,761 (8%) suffered a MC. No difference was found in the risk-adjusted incidence of MC by proportion of older trauma seen. A MC was associated with 34% of all deaths. Of those that suffered a MC, 7413 (24%) died and 76% were successfully rescued. Centres treating higher proportions of older trauma were more successful at rescuing patients after a MC occurred. Patients seen at centres that treat >50% older trauma were 33% (OR=0.67, 95% CI 0.47-0.96) less likely to die following a MC than in centres treating a low proportion (10%) of older trauma. CONCLUSIONS Centres more experienced at managing geriatric trauma are more successful at rescuing older patients with serious complications. Processes of care at these centres need to be further examined and used to inform appropriate interventions.
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Affiliation(s)
- Syed Nabeel Zafar
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Adil A Shah
- Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA; Division of General Surgery, Mayo Clinic, Scottsdale, AZ, USA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Zain G Hashmi
- Department of Surgery, Sinai Hospital, Baltimore, MD, USA
| | - Wendy R Greene
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward E Cornwell
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
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Mans S, Reinders Folmer E, de Jongh MAC, Lansink KWW. Direct transport versus inter hospital transfer of severely injured trauma patients. Injury 2016; 47:26-31. [PMID: 26510409 DOI: 10.1016/j.injury.2015.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/30/2015] [Accepted: 09/26/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several studies have suggested that severely injured patients should be transported directly to a trauma centre bypassing the nearest hospital. However, the evidence remains inconclusive. The purpose of this study was to examine the benefits in terms of mortality of direct transport to a trauma centre versus primary treatment in a level II or III centre followed by inter hospital transfer to a trauma centre for severely injured patients without Traumatic Brain Injury (TBI). PATIENTS AND METHODS We used the regional trauma registry and included all patients with an Injury Severity Score (ISS) >15 and an Abbreviated Injury Score <4 for head injury. We adjusted for survival bias by including "potential transfers": patients who died at the nearest hospitals before transportation to a trauma centre. RESULTS A total of 439 patients was included. The majority of patients (349/439, 79%) was transported directly to the level I trauma centre (direct group). The transferred group was formed by the remaining 90 patients, of whom 81 were transferred to the level I trauma centre after initial stabilisation elsewhere and 9 patients died in the emergency room before transfer to a level 1 trauma centre could occur. There were no significant differences in baseline and injury characteristics between the groups. Overall, 60 patients died in-hospital including 41 of the 349 patients (12%) in the direct group and 19 of the 90 patients (21%) in the transferred group. Nine of the 19 deaths in the transferred group were ascribed to potential transfers. After adjusting for prehospital Revised Trauma Score (RTS) and ISS, the odds ratio of death was 2.40 (95%CI: 1.07-5.40) for patients in the transfer group. When potential transfer patients were excluded from the analysis, the adjusted odds ratio of death was 1.14 (95%CI: 0.43-3.01). CONCLUSIONS After adjusting for survivor bias by including potential transfers, the results of this study suggest a lower risk of death for patients who are directly transported to a level I trauma centre than for patients who receive primary treatment in a level II or III centre and are transferred to a trauma centre. However, this finding was only significant when adjusting for survival bias and therefore we conclude that it is still uncertain if there is a lower risk of death for patients who are transported directly to a level I trauma centre.
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Affiliation(s)
- Stefan Mans
- Trauma Centre Brabant, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | | | | | - Koen W W Lansink
- Trauma Centre Brabant, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands; Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Barr LV, Vindlacheruvu M, Gooding CR. The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients. Injury 2015; 46:384-7. [PMID: 25548113 DOI: 10.1016/j.injury.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 10/21/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
Twenty-two major trauma centres (MTCs) became operational across England on 1st April 2012. The aim of this study was to ascertain whether becoming an MTC has affected outcomes for elderly hip fracture patients at our institution. Eight hundred and twenty-four patients aged ≥60 years who sustained 841 consecutive hip fractures over a two-year period were included. There were 381 fractures during the year prior to (pre-MTC group), and 460 fractures during the year after (post-MTC group) becoming an MTC. Outcomes analysed were time to theatre, length of acute hospital stay, post-operative complications, and mortality at 30, 120 and 365 days. No statistically significant difference was found in median length of stay between the two groups (13 days vs 14 days, p=0.2888). In the post-MTC group there was a significant increase in median delay to theatre for medically fit patients (25.5h vs 31.5h, p<0.0001), and there was a significant increase in post-operative medical complications (29.7% vs 37.6%, p=0.0160). There was no statistically significant difference in overall mortality rates, however 30-day mortality rose from 4.7% to 8.0% (p=0.0678). These results suggest that becoming an MTC has led to a significant increase in the delay to surgical management of our hip fracture patients with consequent increases in morbidity and mortality.
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Affiliation(s)
- Lynne V Barr
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
| | - Madhavi Vindlacheruvu
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Chris R Gooding
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
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Abstract
In last 20 years a progressive increase in the cases of road traffic accidents is seen in the institution. In this study efforts have been made to study epidemiology of trauma & how to help the trauma victims in a better way. To study the changing trends in incidence & presentation of trauma victims. To recommend preventive measures based on the analysis. The present study was carried out in MGIMS, Sewagram, Wardha from 2001 to 2003. For this study which is retrospective and prospective, a total of 986 cases of surgical trauma were studied. Present study showed that in this rural area accidents account for maximum trauma admissions & major trauma only in 20 %. Out of 986 patients, 78.8 % required repair of wounds, 3.8 % required exploratory laparotomy and 16.3 % had orthopedic interventions. Overall mortality rate was 2.9 %. It was found that general care in wards was good in terms of trauma results of rural areas. These results may vary when compared with specialized trauma centers in cities; however after a period of few years cost effectiveness of trauma centers in terms of benefits needs an assessment*.
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Affiliation(s)
- Gaurav C. Gupta
- Department of surgery, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra India
| | - K. B. Golhar
- Department of surgery, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra India
| | - V. K. Mehta
- Department of surgery, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra India
| | - D. Swapnil
- Department of surgery, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra India
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Caputo LM, Salottolo KM, Slone DS, Mains CW, Bar-Or D. The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence. Injury 2014; 45:478-86. [PMID: 24129325 DOI: 10.1016/j.injury.2013.09.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/20/2013] [Accepted: 09/21/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To synthesise published and unpublished findings examining the relationship between institutional trauma centre volume or trauma patient volume per surgeon and mortality. BACKGROUND Evidence on the relationship between patient volume and survival in trauma patients is inconclusive in the literature and remains controversial. METHODS A literature search was performed to identify studies published between 1976 and 2013 via MEDLINE (Pubmed) and the Cumulative Index to Nursing and Allied Health Literature (EbscoHost) as well as footnote chasing. Abstracts from appropriate conferences and ProQuest Dissertations and Theses were also searched. Inclusion criteria required studies to be original research published in English that examined the relationship between mortality and either institutional or per surgeon volume in American trauma centres. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement checklist and flowchart. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the quality of the evidence. RESULTS Of 1392 studies reviewed, 19 studies met defined inclusion criteria; all studies were retrospective. The definition of volume was heterogeneous across the studies. Patient population and analysis methods also varied across the studies. Sixteen studies (84%) examined the relationship between institutional trauma centre volume and mortality. Of the 16 studies, 12 examined the volume of severely injured patients and eight examined overall trauma patient volume. High institutional volume was associated with at least somewhat improved mortality in ten of 16 studies (63%); however, nearly half of these studies found only some subpopulations experienced benefits. In the remaining six studies, volume was not associated with any benefits. Four studies (25%) analysed the impact of surgeon volume on mortality. High volume per surgeon was associated with improved mortality in only one of four studies (25%). CONCLUSIONS The studies were extremely heterogeneous, thus definitive conclusions cannot be drawn regarding optimal volume before a clear advantage in survival is observed. A prospective study defining volume as a continuous variable is warranted to support current admission criteria for American trauma patients.
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Affiliation(s)
- Lisa M Caputo
- Trauma Research Department, Swedish Medical Department, Englewood, CO 80113, United States
| | - Kristin M Salottolo
- Trauma Research Department, Swedish Medical Department, Englewood, CO 80113, United States
| | - Denetta Sue Slone
- Trauma Services Department, Swedish Medical Center, Englewood, CO 80113, United States
| | - Charles W Mains
- Trauma Services Department, St. Anthony Hospital, Lakewood, CO 80228, United States; Rocky Vista University, Parker, CO 80134, United States
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Department, Englewood, CO 80113, United States; Rocky Vista University, Parker, CO 80134, United States.
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