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Conrick KM, Mills B, Fuentes M, Graves JM, St. Vil C, Vavilala MS, Bulger EM, Arbabi S, Rowhani-Rahbar A, Moore M. Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach. Health Equity 2024; 8:249-253. [PMID: 38595933 PMCID: PMC11002320 DOI: 10.1089/heq.2023.0044] [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] [Accepted: 01/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Limited availability and poor quality of data in medical records and trauma registries impede progress to achieve injury-related health equity across the lifespan. Methods We used a Nominal Group Technique (NGT) in-person workgroup and a national web-based Delphi process to identify common data elements (CDE) that should be collected. Results The 12 participants in the NGT workgroup and 23 participants in the national Delphi process identified 10 equity-related CDE and guiding lessons for research on collection of these data. Conclusions These high-priority CDE define a detailed, equity-oriented approach to guide research to achieve injury-related health equity across the lifespan.
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Affiliation(s)
- Kelsey M. Conrick
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Brianna Mills
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Molly Fuentes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Janessa M. Graves
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | | | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Eileen M. Bulger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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Gendler S, Gelikas S, Talmy T, Nadler R, Tsur AM, Radomislensky I, Bodas M, Glassberg E, Almog O, Benov A, Chen J. Predictors of Short-Term Trauma Laparotomy Outcomes in an Integrated Military-Civilian Health System: A 23-Year Retrospective Cohort Study. J Clin Med 2024; 13:1830. [PMID: 38610595 PMCID: PMC11012665 DOI: 10.3390/jcm13071830] [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: 01/06/2024] [Revised: 02/03/2024] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Trauma laparotomy (TL) remains a cornerstone of trauma care. We aimed to investigate prehospital measures associated with in-hospital mortality among casualties subsequently undergoing TLs in civilian hospitals. Methods: This retrospective cohort study cross-referenced the prehospital and hospitalization data of casualties treated by Israel Defense Forces-Medical Corps teams who later underwent TLs in civilian hospitals between 1997 and 2020. Results: Overall, we identified 217 casualties treated by IDF-MC teams that subsequently underwent a TL, with a mortality rate of 15.2% (33/217). The main mechanism of injury was documented as penetrating for 121/217 (55.8%). The median heart rate and blood pressure were within the normal limit for the entire cohort, with a low blood pressure predicting mortality (65 vs. 127, p < 0.001). In a multivariate analysis, prehospital endotracheal intubation (ETI), emergency department Glasgow coma scores of 3-8, and the need for a thoracotomy or bowel-related procedures were significantly associated with mortality (OR 6.8, p < 0.001, OR = 48.5, p < 0.001, and OR = 4.61, p = 0.002, respectively). Conclusions: Prehospital interventions introduced throughout the study period did not lead to an improvement in survival. Survival was negatively influenced by prehospital ETI, reinforcing previous observations of the potential deleterious effects of definitive airways on hemorrhaging trauma casualties. While a low blood pressure was a predictor of mortality, the median systolic blood pressure for even the sickest patients (ISS > 16) was within normal limits, highlighting the challenges in triage and risk stratification for trauma casualties.
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Affiliation(s)
- Sami Gendler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
| | - Shaul Gelikas
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Department of Medicine, Sheba Medical Center, Tel-Hashomer 5262504, Israel
| | - Tomer Talmy
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
| | - Roy Nadler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
| | - Avishai M. Tsur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Department of Medicine, Sheba Medical Center, Tel-Hashomer 5262504, Israel
| | - Irina Radomislensky
- The National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 5262100, Israel
| | - Moran Bodas
- The National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 5262100, Israel
- Department of Emergency & Disaster Management, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo 6139001, Israel
| | - Elon Glassberg
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
- The Uniformed Services, University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ofer Almog
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
| | - Jacob Chen
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
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Rogers FB, Larson NJ, Dries DJ, Olson-Bullis BA, Blondeau B. The State of the Union: Trauma System Development in the United States. J Intensive Care Med 2023:8850666231216360. [PMID: 37981752 DOI: 10.1177/08850666231216360] [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] [Indexed: 11/21/2023]
Abstract
Injury is both a national and international epidemic that affects people of all age, race, religion, and socioeconomic class. Injury was the fourth leading cause of death in the United States (U.S.) in 2021 and results in an incalculable emotional and financial burden on our society. Despite this, when prevention fails, trauma centers allow communities to prepare to care for the traumatically injured patient. Using lessons learned from the military, trauma care has grown more sophisticated in the last 50 years. In 1966, the first civilian trauma center was established, bringing management of injury into the new age. Now, the American College of Surgeons recognizes 4 levels of trauma centers (I-IV), with select states recognizing Level V trauma centers. The introduction of trauma centers in the U.S. has been proven to reduce morbidity and mortality for the injured patient. However, despite the proven benefits of trauma centers, the U.S. lacks a single, unified, trauma system and instead operates within a "system of systems" creating vast disparities in the level of care that can be received, especially in rural and economically disadvantaged areas. In this review we present the history of trauma system development in the U.S, define the different levels of trauma centers, present evidence that trauma systems and trauma centers improve outcomes, outline the current state of trauma system development in the U.S, and briefly mention some of the current challenges and opportunities in trauma system development in the U.S. today.
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Affiliation(s)
| | | | - David J Dries
- Department of Surgery, Regions Hospital, St. Paul, MN, USA
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Foppen W, Claassen Y, Falck D, van der Meer NJM. Trauma Patient Volume and the Quality of Care: A Scoping Review. J Clin Med 2023; 12:5317. [PMID: 37629358 PMCID: PMC10455163 DOI: 10.3390/jcm12165317] [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: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Healthcare stakeholders in the Netherlands came to an agreement in 2022 to deal with present and future challenges in healthcare. Among others, this agreement contains clear statements regarding the concentration of trauma patients, including the minimal required number of annual severe trauma patients for Major Trauma Centers. This review investigates the effects of trauma patient volumes on several domains of the quality of healthcare. METHODS PubMed was searched; studies published during the last 10 years reporting quantitative data on trauma patient volume and quality of healthcare were included. Results were summarized and categorized into the quality domains of healthcare. RESULTS Seventeen studies were included with a total of 1,517,848 patients. A positive association between trauma patient volume and survival was observed in 11/13 studies with adjusted analyses. Few studies addressed other quality domains: efficiency (n = 5), safety (n = 2), and time aspects of care (n = 4). None covered people-centeredness, equitability, or integrated care. CONCLUSIONS Most studies showed a better survival of trauma patients when treated in high-volume hospitals compared to lower volume hospitals. However, the ideal threshold could not be determined. The association between trauma volume and other domains of the quality of healthcare remains unclear.
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Affiliation(s)
- Wouter Foppen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Yvette Claassen
- Department of Surgery, Leids Universitair Medisch Centrum, 2333 ZA Leiden, The Netherlands
| | - Debby Falck
- Department of Neurology, HagaZiekenhuis, 2545 AA The Hague, The Netherlands
| | - Nardo J. M. van der Meer
- Department of Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
- TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands
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Moore L, Thakore J, Evans D, Stelfox HT, Razek T, Kortbeek J, Watson I, Evans C, Erdogan M, Engels P, Haas B, Esmail R, Green R, Lampron J, Wiebe M, Clément J, Gezer R, McMillan J, Neveu X, Tardif PA, Coates A, Yanchar NL. Injury outcomes across Canadian trauma systems: a historical cohort study. Can J Anaesth 2023; 70:1350-1361. [PMID: 37386268 DOI: 10.1007/s12630-023-02522-2] [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: 06/15/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Most North American trauma systems have designated trauma centres (TCs) including level I (ultraspecialized high-volume metropolitan centres), level II (specialized medium-volume urban centres), and/or level III (semirural or rural centres). Trauma system configuration varies across provinces and it is unclear how these differences influence patient distributions and outcomes. We aimed to compare patient case mix, case volumes, and risk-adjusted outcomes of adults with major trauma admitted to designated level I, II, and III TCs across Canadian trauma systems. METHODS In a national historical cohort study, we extracted data from Canadian provincial trauma registries on major trauma patients treated between 2013 and 2018 in all designated level I, II, or III TCs in British Columbia, Alberta, Quebec, and Nova Scotia; level I and II TCs in New Brunswick; and four TCs in Ontario. We used multilevel generalized linear models to compare mortality and intensive care unit (ICU) admission and competitive risk models for hospital and ICU length of stay (LOS). Ontario could not be included in outcome comparisons because there were no population-based data from this province. RESULTS The study sample comprised 50,959 patients. Patient distributions in level I and II TCs were similar across provinces but we observed significant differences in case mix and volumes for level III TCs. There was low variation in risk-adjusted mortality and LOS across provinces and TCs but interprovincial and intercentre variation in risk-adjusted ICU admission was high. CONCLUSIONS Our results suggest that differences in the functional role of TCs according to their designation level across provinces leads to significant variations in the distribution of patients, case volumes, resource use, and clinical outcomes. These results highlight opportunities to improve Canadian trauma care and underline the need for standardized population-based injury data to support national quality improvement efforts.
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Affiliation(s)
- Lynne Moore
- Santé des Populations et Pratiques Optimales en Santé (Traumatologie - Urgence - Soins intensifs), Centre de Recherche du CHU de Québec, Quebec City, QC, Canada.
- Department of Social and Preventive Medicine, Enfant-Jésus Hospital, Université Laval, 1401, 18e rue, local H-012a, Quebec City, QC, G1J 1Z4, Canada.
| | - Jaimini Thakore
- Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - David Evans
- Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Tarek Razek
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - John Kortbeek
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ian Watson
- New Brunswick Trauma Program, Saint John, NB, Canada
| | - Christopher Evans
- Kingston Health Sciences Centre, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Mete Erdogan
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
| | - Paul Engels
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Barbara Haas
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rosmin Esmail
- Trauma Services, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
- Departments of Oncology and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Robert Green
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Jacinthe Lampron
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Micheline Wiebe
- BC Trauma Registry, Provincial Health Services Authority of British Columbia, Vancouver, BC, Canada
| | - Julien Clément
- Institut National d'Excellence en Santé et en Services Sociaux, Quebec City, QC, Canada
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Recep Gezer
- Trauma Services BC, Provincial Health Services Authority of British Columbia, Vancouver, BC, Canada
| | - Jennifer McMillan
- BC Trauma Registry, Provincial Health Services Authority of British Columbia, Vancouver, BC, Canada
| | - Xavier Neveu
- Santé des Populations et Pratiques Optimales en Santé (Traumatologie - Urgence - Soins intensifs), Centre de Recherche du CHU de Québec, Quebec City, QC, Canada
| | - Pier-Alexandre Tardif
- Santé des Populations et Pratiques Optimales en Santé (Traumatologie - Urgence - Soins intensifs), Centre de Recherche du CHU de Québec, Quebec City, QC, Canada
| | - Angela Coates
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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Tatebe LC, Ho VP, Santry HP, Tatebe K. Redefining trauma deserts: novel technique to accurately map prehospital transport time. Trauma Surg Acute Care Open 2023; 8:e001013. [PMID: 36704643 PMCID: PMC9872504 DOI: 10.1136/tsaco-2022-001013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/07/2023] [Indexed: 01/25/2023] Open
Abstract
Background Prehospital transport time has been directly related to mortality for hemorrhaging trauma patients. 'Trauma deserts' were previously defined as being outside of a 5-mile radial distance of an urban trauma center. We postulated that the true 'desert' should be based on transport time rather than transport distance. Methods Using the Chicagoland area that was used to describe 'trauma deserts,' a sequential process to query a commercial travel optimization product to map transport times over coordinates that covered the entire urban area at a particular time of day. This produces a heat map representing prehospital transport times. Travel times were then limited to 15 minutes to represent a temporally based map of transport capabilities. This was repeated during high and low traffic times and for centers across the city. Results We demonstrated that the temporally based map for transport to a trauma center in an urban center differs significantly from the radial distance to the trauma center. Primary effects were proximity to highways and the downtown area. Transportation to centers were significantly different when time was considered instead of distance (p<0.001). We were further able to map variations in traffic patterns and thus transport times by time of day. The truly 'closest' trauma center by time changed based on time of day and was not always the closest hospital by distance. Discussion As the crow flies is not how the ambulance drives. This novel technique of dynamically mapping transport times can be used to create accurate trauma deserts in an urban setting with multiple trauma centers. Further, this technique can be used to quantify the potential benefit or detriment of adding or removing firehouses or trauma centers.
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Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vanessa P Ho
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Heena P Santry
- Department of Surgery, Kettering Hospital, Columbus, Ohio, USA
| | - Ken Tatebe
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, USA
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Ferre AC, Curtis J, Flippin JA, Claridge JA, Tseng ES, Brown LR, Ho VP. Do new trauma centers provide needed or redundant access? A nationwide analysis. J Trauma Acute Care Surg 2022; 93:347-352. [PMID: 35647793 PMCID: PMC9615221 DOI: 10.1097/ta.0000000000003652] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Our prior research has demonstrated that increasing the number of trauma centers (TCs) in a state does not reliably improve state-level injury-related mortality. We hypothesized that many new TCs would serve populations already served by existing TCs, rather than in areas without ready TC access. We also hypothesized that new TCs would also be less likely to serve economically disadvantaged populations. METHODS All state-designated adult TCs registered with the American Trauma Society in 2014 and 2019 were mapped using ArcGIS Pro (ESRI Inc., Redlands, CA). Trauma centers were grouped as Level 1 or 2 (Lev12) or Level 3, 4 or 5 (Lev345). We also obtained census tract-level data (73,666 tracts), including population counts and percentage of population below the federal poverty threshold. Thirty-minute drive-time areas were created around each TC. Census tracts were considered "served" if their geographic centers were located within a 30-minute drive-time area to any TC. Data were analyzed at the census tract level. RESULTS A total of 2,140 TCs were identified in 2019, with 256 new TCs and 151 TC closures. Eighty-two percent of new TCs were Levels 3 to 5. Nationwide, coverage increased from 75.3% of tracts served in 2014 to 78.1% in 2019, representing an increased coverage from 76.0% to 79.4% of the population. New TC served 17,532 tracts, of which 87.3% were already served. New Lev12 TCs served 9,100 tracts, of which 91.2% were already served; new Lev345 TCs served 15,728 tracts, of which 85.9% were already served. Of 2,204 newly served tracts, those served by Lev345 TCs had higher mean percentage poverty compared with those served by Lev12 TCs (15.7% vs. 13.2% poverty, p < 0.05). DISCUSSION Overall, access to trauma care has been improving in the United States. However, the majority of new TCs opened in locations with preexisting access to trauma care. Nationwide, Levels 3, 4, and 5 TCs have been responsible for expanding access to underserved populations. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
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Affiliation(s)
- Alexandra C. Ferre
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, OH
- Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Jacqueline Curtis
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH
| | - J. Alford Flippin
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, OH
| | - Jeffrey A. Claridge
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, OH
| | - Esther S. Tseng
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, OH
| | - Laura R. Brown
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, OH
| | - Vanessa P. Ho
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH
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Garbett H, Carter B, Gregory A, Cramer H, Lewis NV, Morgan K, Thompson J, Feder G, Braude P. Domestic violence and injuries: prevalence and patterns-a pilot database study to identify suspected cases in a UK major trauma centre. Inj Prev 2022; 28:injuryprev-2021-044481. [PMID: 35613902 DOI: 10.1136/injuryprev-2021-044481] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Victim-survivors of domestic violence and abuse (DVA) present to secondary care with isolated injuries to the head, limb or face. In the UK, there are no published studies looking at the relationship of significant traumatic injuries in adults and the relationship to DVA.The primary objective was to assess the feasibility of using a tailored search method to identify cases of suspected DVA in the national audit database for trauma. The secondary objective was to assess the association of DVA with clinical characteristics. METHODS We undertook a single-centre retrospective observational cohort pilot study. Data were analysed from the local Trauma and Audit Research Network (TARN) database. The 'Scene Description' field in the database was searched using a tailored search strategy. Feasibility was evaluated with notes review and assessed by the PPV and prevalence. Secondary objectives used a logistic regression in Excel. RESULTS This method of identifying suspected cases of DVA from the TARN database is feasible. The PPV was 100%, and the prevalence of suspected DVA in the study period was 3.6 per 1000 trauma discharges. Of those who had experienced DVA, 52.7% were male, median age 43 (IQR: 33-52) and mortality 5.5%. Subgroup analysis of older people demonstrated longer hospital stay (p=0.17) and greater likelihood of admission to intensive care (OR 2.60, 95% CI 0.48 to 14.24). CONCLUSION We have created a feasible methodology to identify suspected DVA-related injuries within the TARN database. Future work is needed to further understand this relationship on a national level.
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Affiliation(s)
- Hollie Garbett
- Department of Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Ben Carter
- Department of Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Alison Gregory
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Natalia V Lewis
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Karen Morgan
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Julian Thompson
- North Bristol NHS Trust, Severn Major Trauma Network, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Philip Braude
- Department of Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
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Tonkins M, Bradbury D, Bramley P, Sabir L, Wilkinson A, Lecky F. Care of the older trauma patient following low-energy transfer trauma-highlighting a research void. Age Ageing 2022; 51:6561969. [PMID: 35380606 DOI: 10.1093/ageing/afac074] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND in high-income countries trauma patients are becoming older, more likely to have comorbidities, and are being injured by low-energy mechanisms. This systematic review investigates the association between higher-level trauma centre care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma. METHODS a systematic review was conducted in January 2021. Studies were eligible if they reported outcomes in adults admitted to hospital due to low-energy trauma. In the presence of study heterogeneity, a narrative synthesis was pre-specified. RESULTS three studies were included from 2,898 unique records. The studies' risk of bias was moderate-to-serious. All studies compared outcomes in trauma centres verified by the American College of Surgeons in the USA. The mean/median ages of patients in the studies were 73.4, 74.5 and 80 years. The studies reported divergent results. One demonstrated improved outcomes in level 3 or 4 trauma centres (Observed: Expected Mortality 0.973, 95% CI: 0.971-0.975), one demonstrated improved outcomes in level 1 trauma centres (Adjusted Odds Ratio 0.71, 95% CI: 0.56-0.91), and one demonstrated no difference between level 1 or 2 and level 3 or 4 trauma centre care (adjusted odds ratio 0.91, 95% CI: 0.80-1.04). CONCLUSIONS the few relevant studies identified provided discordant evidence for the value of major trauma centre care following low-energy trauma. The main implication of this review is the paucity of high-quality research into the optimum care of patients injured in low-energy trauma. Further studies into triage, interventions and research methodology are required.
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Affiliation(s)
- Michael Tonkins
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Paul Bramley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lisa Sabir
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Anna Wilkinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Fiona Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Denu ZA, Osman MY, Bisetegn TA, Biks GA, Gelaye KA. Barriers and opportunities of establishing an integrated prehospital emergency response system in North West Ethiopia: a qualitative study. Inj Prev 2022; 28:347-352. [PMID: 35228314 PMCID: PMC9340032 DOI: 10.1136/injuryprev-2021-044487] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/30/2022] [Indexed: 12/02/2022]
Abstract
Background Prehospital emergency care helps to reduce mortality and morbidity from time-sensitive conditions. In this study, we summarised the perspectives of various stakeholders on the establishment of a prehospital integrated emergency response system. Methods We conducted a qualitative study using a key informant interview. We used a purposive sampling technique to select participants from the sector offices based on their proximity to the problem under consideration. We took verbal informed consent from each participant before the interviews. We conducted a thematic content analysis. Results Twenty-three study participants, working at six sector offices (the zonal health office, University of Gondar, traffic office, fire extinguisher office, the Amhara regional health bureau and the Ethiopian red cross association), were included in this study. Five major themes have emerged. The themes that emerged include participants’ views on the importance of prehospital service, barriers and opportunities for establishing the system, and how to start and sustain the system. Conclusion and recommendation Lack of resources is not the main reason for the lack of prehospital emergency care in the study area rather; lack of commitment, ownership and high turnover of decision-makers were the main reasons for the absence of prehospital care, as viewed by respondents. On the other side, the availability of professionals, training institutions and the fact that emergency care is a shared agenda by different stakeholders were stated as an opportunity to establish the system. With the growing number of injuries and non-communicable diseases, emergency management should get due attention.
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Affiliation(s)
- Zewditu Abdissa Denu
- Anaesthesia, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Mensur Yassin Osman
- Surgery, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Communication and Behavioral Science, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health Policy and Management, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Anaesthesia, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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11
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Gabbe BJ, Veitch W, Mather A, Curtis K, Holland AJA, Gomez D, Civil I, Nathens A, Fitzgerald M, Martin K, Teague WJ, Joseph A. Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen? Br J Anaesth 2021; 128:e158-e167. [PMID: 34863512 DOI: 10.1016/j.bja.2021.10.038] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 01/06/2023] Open
Abstract
Mass casualty incidents (MCIs) are diverse, unpredictable, and increasing in frequency, but preparation is possible and necessary. The nature of MCIs requires a trauma response but also requires effective and tested disaster preparedness planning. From an international perspective, the aims of this narrative review are to describe the key components necessary for optimisation of trauma system preparedness for MCIs, whether trauma systems and centres meet these components and areas for improvement of trauma system response. Many of the principles necessary for response to MCIs are embedded in trauma system design and trauma centre function. These include robust communication networks, established triage systems, and capacity to secure centres from threats to safety and quality of care. However, evidence from the current literature indicates the need to strengthen trauma system preparedness for MCIs through greater trauma leader representation at all levels of disaster preparedness planning, enhanced training of staff and simulated disaster training, expanded surge capacity planning, improved staff management and support during the MCI and in the post-disaster recovery phase, clear provision for the treatment of paediatric patients in disaster plans, and diversified and pre-agreed systems for essential supplies and services continuity. Mass casualty preparedness is a complex, iterative process that requires an integrated, multidisciplinary, and tiered approach. Through effective preparedness planning, trauma systems should be well-placed to deliver an optimal response when faced with MCIs.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea, UK.
| | - William Veitch
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Mather
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kate Curtis
- School of Medicine, University of Sydney, Sydney, Australia; Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney School of Medicine, Westmead, Australia
| | - David Gomez
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Avery Nathens
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mark Fitzgerald
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia
| | - Kate Martin
- Department General Surgical Specialties, Royal Melbourne Hospital, Parkville, Australia
| | - Warwick J Teague
- Trauma Service, Royal Children's Hospital, Parkville, Australia; Surgical Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Anthony Joseph
- Royal North Shore Hospital Clinical School, School of Medicine, University of Sydney, St Leonards, Australia
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12
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Khalil M, Alawwa G, Pinto F, O'Neill PA. Pediatric Mortality at Pediatric versus Adult Trauma Centers. J Emerg Trauma Shock 2021; 14:128-135. [PMID: 34759630 PMCID: PMC8527062 DOI: 10.4103/jets.jets_11_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: Pediatric trauma centers (PTCs) were created to address the unique needs of injured children with the expectation that outcomes would be improved. However, prior studies to evaluate the impact of PTCs have had conflicting results. Our study was conducted to further clarify this question. We hypothesize that severely injured children ≤ 14 years of age have better outcomes at PTCs and that better survival may be due to higher emergency department (ED) survival rates than at adult trauma centers (ATCs). Methods: A retrospective analysis of severely injured children (ISS>15) ≤18 years of age entered into the National Trauma Data Bank (NTDB) between 2011 and 2012 was performed. Subjects were stratified into 2 age cohorts; young children (0-14 years) and adolescents (15-18 years). Primary outcomes were emergency department (ED) and in-patient (IP) mortality. Secondary outcomes included in-hospital complications, hospital and ICU length of stay, and ventilator days. Outcome differences were assessed using multilevel logistic and negative binomial regression analyses. Results: A total of 10,028 children were included. Median ISS was 22 (Interquartile range 17-29). Adjusting for confounders on multivariate analysis, children ≤ 14 had lower odds of ED (0.42[CI 0.25-0.71], p=0.001) and IP mortality (0.73[CI 0.5-0.9], p=0.02) at PTCs. There were no differences in odds of ED mortality (0.81 [CI 0.5-1.3], p=0.4) or IP mortality (1.01 [CI 0.8-1.2], p=0.88) for adolescents between centers. There were no differences in complication rates between PTCs and ATCs (OR 0.86 [CI 0.69-1.06], p=1.7) but children were more likely to be discharged to home and have more ICU and ventilator free days if treated at a PTC. Conclusion: Young children but not adolescents have better ED survival at PTCs compared to ATCs. Level of Evidence: Level IV, Therapeutic
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Affiliation(s)
- Mazhar Khalil
- Department of Surgery, Brookdale Hospital and Medical Center, Brooklyn, New York, USA
| | - Ghayth Alawwa
- Department of Surgery, Brookdale Hospital and Medical Center, Brooklyn, New York, USA
| | - Frederique Pinto
- Department of Surgery, Brookdale Hospital and Medical Center, Brooklyn, New York, USA
| | - Patricia A O'Neill
- Department of Surgery, Brookdale Hospital and Medical Center, Brooklyn, New York, USA
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13
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Abdelrahman H, Al-Thani H, Khan NA, Mollazehi M, Asim M, El-Menyar A. The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center. Int J Environ Res Public Health 2021; 18:8542. [PMID: 34444291 DOI: 10.3390/ijerph18168542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season). Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals. Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (p < 0.001), ICU length of stay (p = 0.001), blood transfusions (p = 0.001), intubations (p = 0.001), mortality rate (9.7% vs. 0.7%; p < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS (p = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; p = 0005), and need for intubation (21% vs. 16%; p = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center. Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.
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14
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Truong EI, Ho VP, Tseng ES, Ngana C, Curtis J, Curfman ET, Claridge JA. Is more better? Do statewide increases in trauma centers reduce injury-related mortality? J Trauma Acute Care Surg 2021; 91:171-177. [PMID: 33843835 PMCID: PMC8487036 DOI: 10.1097/ta.0000000000003178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trauma centers are inconsistently distributed throughout the United States. It is unclear if new trauma centers improve care and decrease mortality. We tested the hypothesis that increases in trauma centers are associated with decreases in injury-related mortality (IRM) at the state level. METHODS We used data from the American Trauma Society to geolocate every state-designated or American College of Surgeons-verified trauma center in all 50 states and the District of Columbia from 2014 to 2018. These data were merged with publicly available IRM data from the Centers for Disease Control and Prevention. We used geographic information systems methods to map and study the relationships between trauma center locations and state-level IRM over time. Regression analysis, accounting for state-level fixed effects, was used to calculate the effect of total statewide number of trauma center on IRM and year-to-year changes in statewide trauma center with the IRM (shown as deaths per additional trauma center per 100,000 population, p value). RESULTS Nationwide between 2014 and 2018, the number of trauma center increased from 2,039 to 2,153. Injury-related mortality also increased over time. There was notable interstate variation, from 1 to 284 trauma centers. Four patterns in statewide trauma center changes emerged: static (12), increased (29), decreased (5), or variable (4). Of states with trauma center increases, 26 (90%) had increased IRM between 2014 and 2017, while the remaining 3 saw a decline. Regression analysis demonstrated that having more trauma centers in a state was associated with a significantly higher IRM rate (0.38, p = 0.03); adding new trauma centers was not associated with changes in IRM (0.02, p = 0.8). CONCLUSION Having more trauma centers and increasing the number of trauma center within a state are not associated with decreases in state-level IRM. In this case, more is not better. However, more work is needed to identify the optimal number and location of trauma centers to improve IRM. LEVEL OF EVIDENCE Epidemiologic, level III; Care management, level III.
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Affiliation(s)
- Evelyn I. Truong
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Vanessa P. Ho
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Esther S. Tseng
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Colette Ngana
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Jacqueline Curtis
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Eric T. Curfman
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey A. Claridge
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
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15
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Clery MJ, Hudson PJ, Moore JC, Mercer Kollar LM, Wu DT. Exploring injury intentionality and mechanism via ICD-10-CM injury codes and self-reported injury in a large, urban emergency department. Inj Prev 2021; 27:i62-i65. [PMID: 33674335 PMCID: PMC7948174 DOI: 10.1136/injuryprev-2019-043508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 11/04/2022]
Abstract
Health systems capture injuries using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes and share data with public health to inform injury surveillance. This study analyses provider-assigned ICD-10-CM injury codes among self-reported injuries to determine the effectiveness of ICD-10-CM coding in capturing injury and assault. METHODS Self-reported injury screen records from an urban, level 1 trauma centre collected between 20 November 2015 and 30 September 2019 were compared with corresponding provider-assigned ICD-10-CM codes discerning the frequency in which intentions are indicated among patients reporting (1) any injury and (2) assault. RESULTS Of 380 922 patients screened, 32 788 (8.61%) reported any injury and 6763 (1.78%) reported assault. ICD-10-CM codes had a sensitivity of 67.40% (95% CI 66.89% to 67.91%) for any injury and specificity of 89.79% (95% CI 89.69% to 89.89%]). For assault, ICD-10-CM codes had sensitivity of 2.25% (95% CI 1.91% to 2.63%) and specificity of 99.97% (95% CI 99.97% 99.98%). DISCUSSION This study found provider-assigned ICD-10-CM had limited sensitivity to identify injury and low sensitivity for assault. This study more fully characterises ICD-10-CM coding system effectiveness in identifying assaults.
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Affiliation(s)
- Michael J Clery
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Philip Joseph Hudson
- Injury Prevention Program, Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | - Laura M Mercer Kollar
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel T Wu
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
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Ajayi B, Guthrie H, Trompeter A, Tennent D, Lui DF. The rising burden of penetrating knife injuries. Inj Prev 2021; 27:467-471. [PMID: 33574129 DOI: 10.1136/injuryprev-2020-044016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/05/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Knife crime remains an area of public health concern. In order to tackle this problem and reduce its burden, the epidemiology of penetrating knife injuries needs to be understood. The aim of this study is to analyse the pattern of knife injuries at a major trauma centre (MTC) in London. METHODS An analysis of cases from the prospectively collected Trauma Audit and Research Network database of patients attending the emergency department with violent intentional knife injuries from January 2014 to December 2018 was performed. Registry data were analysed for mechanism of injury, number of stabbings, month/date/time of admission, patient demographics, anatomical pattern of injury, hospital length of stay, intervention, ethnicity, repeat victims and fatality. RESULTS 1373 penetrating knife injuries activated the major trauma call representing 11.7% of all major trauma alerts. 44% occurred in the 16-25 years age group and 85.6% were male. 67.2% required hospital admission. 14.1% required surgery. 50.3% required intervention from multiple specialities. 39.4% had thoracic injuries and 25.8% abdominal injuries. Fatality rate was 0.9% (n=12). 3.6% were repeat victims. 26.8% were multiple stabbings. 5.2% were deliberate self-harm. 23.2% were of white ethnic background. Injury incidence peaked on a Saturday. A significant peak in injuries occurred between 22:00 and 00:00. CONCLUSION This study shows an increase in the incidence of knife crime per year. These cases contribute approximately 12% of major trauma calls. Female assaults increased from 8.4% to 14.3%. Approximately 2/3 injuries occur in the thorax and abdomen with high frequencies at weekends and evenings. These facts can help allocate resources more efficiently.
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Affiliation(s)
- Bisola Ajayi
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Hugo Guthrie
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alex Trompeter
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Duncan Tennent
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Darren F Lui
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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Elkbuli A, Dowd B, Sanchez C, Shaikh S, Sutherland M, McKenney M. Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response. Am Surg 2021; 88:1090-1096. [PMID: 33517710 DOI: 10.1177/0003134820988827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. METHODS A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. RESULTS Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS (P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS (P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes (P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). CONCLUSIONS Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Brianna Dowd
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Carol Sanchez
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Saamia Shaikh
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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Abstract
BACKGROUND As the United States (US) population increases, the demand for more trauma surgeons (TSs) will increase. There are no recent studies comparing the TS density temporally and geographically. We aim to evaluate the density and distribution of TSs by state and region and its impact on trauma patient mortality. METHODS A retrospective cohort analysis of the American Medical Association Physician Masterfile (PM), 2016 US Census Bureau, and Centers for Disease Control and Prevention (CDC's) Web-based Injury Statistics Query and Reporting System (WISQARS) to determine TS density. TS density was calculated by dividing the number of TSs per 1 000 000 population at the state level, and divided by 500 admissions at the regional level. Trauma-related mortality by state was obtained through the CDC's WISQARS database, which allowed us to estimate trauma mortality per 100 000 population. RESULTS From 2007 to 2014, the net increase of TS was 3160 but only a net increase of 124 TSs from 2014 to 2020. Overall, the US has 12.58 TSs/1 000 000 population. TS density plateaued from 2014 to 2020. 33% of states have a TS density of 6-10/1 000 000 population, 43% have a density of 10-15, 12% have 15-20, and 12% have a density >20. The Northeast has the highest density of TSs per region (2.95/500 admissions), while the Midwest had the lowest (1.93/500 admissions). CONCLUSION The density of TSs in the US varies geographically, has plateaued nationally, and has implications on trauma patient mortality. Future studies should further investigate causes of the TS shortage and implement institutional and educational interventions to properly distribute TSs across the US and reduce geographic disparities.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Carol Sanchez
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Huazhi Liu
- Department of Surgery, 23703Ocala Regional Medical Center, Ocala, FL, USA.,University of Central Florida, Orlando, FL, USA
| | - Darwin Ang
- Department of Surgery, 23703Ocala Regional Medical Center, Ocala, FL, USA.,University of Central Florida, Orlando, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
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Kool B, Lilley R, Davie G, Reid P, Civil I, Branas C, de Graaf B, Dicker B, Ameratunga SN. Evaluating the impact of prehospital care on mortality following major trauma in New Zealand: a retrospective cohort study. Inj Prev 2021; 27:582-586. [PMID: 33514568 DOI: 10.1136/injuryprev-2020-044057] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Injury is a leading cause of death and health loss in New Zealand and internationally. The potentially fatal or severe consequences of many injuries can be reduced through an optimally structured prehospital trauma care system that can provide timely and appropriate care. OBJECTIVE To investigate the relationship between emergency medical services (EMS) care and survival to hospital for major trauma cases in New Zealand. METHODS This project is a retrospective cohort study of New Zealand major trauma cases attended by EMS providers over a 2-year period. Outcomes include survival to hospital and survival in hospital for at least 24 hours. The project has three phases: (1) identification of the cohort and assembling a bespoke longitudinal dataset linking EMS, New Zealand Major Trauma Registry and Coronial data; (2) describing the pathways and processes of care to inform an investigation of the relationships between types of EMS care and survival using propensity score modelling to adjust for case-mix differences; (3) assessment of the implications for future practice, policy and research. DISCUSSION The study findings will help identify opportunities to optimise the delivery of EMS care in New Zealand by informing the development or revision of existing major trauma EMS policies and guidelines, and to provide a baseline for monitoring the impact of future initiatives. Establishing an evidence-base will support a whole-of-system appraisal that could include broader complex variables relating to healthcare services throughout the continuum of trauma care.
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Affiliation(s)
- Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pararangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ian Civil
- Trauma Services, Auckland District Health Board, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Bridget Dicker
- Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,St John, Mt Wellington, Auckland, New Zealand
| | - Shanthi N Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand.,Population Health Directorate, Counties Manukau District Health Board, Auckland, New Zealand
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20
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Batomen B, Moore L, Strumpf E, Yanchar NL, Thakore J, Nandi A. Trauma system accreditation and patient outcomes in British Columbia: an interrupted time series analysis. Int J Qual Health Care 2020; 32:677-684. [PMID: 33057668 DOI: 10.1093/intqhc/mzaa133] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 10/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We aim to assess the impact of several accreditation cycles of trauma centers on patient outcomes, specifically in-hospital mortality, complications and hospital length of stay. DESIGN Interrupted time series. SETTING British Columbia, Canada. PARTICIPANTS Trauma patients admitted to all level I and level II trauma centers between January 2008 and March 2018. EXPOSURE Accreditation. MAIN OUTCOMES AND MEASURES We first computed quarterly estimates of the proportions of in-hospital mortality, complications and survival to discharge standardized for change in patient case-mix using prognostic scores and the Aalen-Johansen estimator of the cumulative incidence function. Piecewise regressions were then used to estimate the change in levels and trends for patient outcomes following accreditation. RESULTS For in-hospital mortality and major complications, the impact of accreditation seems to be associated with short- and long-term reductions after the first cycle and only short-term reductions for subsequent cycles. However, the 95% confidence intervals for these estimates were wide, and we lacked the precision to consistently conclude that accreditation is beneficial. CONCLUSIONS Applying a quasi-experimental design to time series accounting for changes in patient case-mix, our results suggest that accreditation might reduce in-hospital mortality and major complications. However, there was uncertainty around the estimates of accreditation. Further studies looking at clinical processes of care and other outcomes such as patient or health staff satisfaction are needed.
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Affiliation(s)
- Brice Batomen
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Meredith Charles House, 1130 Pine Avenue West, Room B9, Montreal, QC, H3A 1A3, Canada.,Institute for Health and Social Policy, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Charles Meredith House, 1030 Pine Avenue W. office # 102, Montreal, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, 1401, 18e rue, local Z-215, Québec (Québec), G1J 1Z4, QC, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health and Department of Economics, McGill University, Purvis Hall, 1020 Pine Ave W. Montreal, QC, H3A 1A2, Canada
| | - Natalie L Yanchar
- Clinical Professor in Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Jaimini Thakore
- Provincial Lead, Data, Evaluation & Analytics, Trauma Services BC, Bristish Columbia, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Meredith Charles House, 1130 Pine Avenue West, Room B9, Montreal, QC, H3A 1A3, Canada.,Institute for Health and Social Policy, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Charles Meredith House, 1030 Pine Avenue W. office # 102, Montreal, Canada
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Dooley JH, Dennis BM, Magnotti LJ, Sharpe JP, Guillamondegui OD, Croce MA, Fischer PE. Is NBATS-2 up to the Task? Actual vs. Predicted Patient Volume Shifts With the Addition of Another Trauma Center. Am Surg 2020; 87:595-601. [PMID: 33131286 DOI: 10.1177/0003134820952383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Version 2 of the Needs-Based Assessment of Trauma Systems (NBATS) tool quantifies the impact of an additional trauma center on a region. This study applies NBATS-2 to a system where an additional trauma center was added to compare the tool's predictions to actual patient volumes. METHODS Injury data were collected from the trauma registry of the initial (legacy) center and analyzed geographically using ArcGIS. From 2012 to 2014 ("pre-"period), one Level 1 trauma center existed. From 2016 to 2018 ("post-"period), an additional Level 2 center existed. Emergency medical service (EMS) destination guidelines did not change and favored the legacy center for severely injured patients (Injury Severity Score (ISS) >15). NBATS-2 predicted volume was compared to the actual volume received at the legacy center in the post-period. RESULTS 4068 patients were identified across 14 counties. In the pre-period, 72% of the population and 90% of injuries were within a 45-minute drive of the legacy trauma center. In the post-period, 75% of the total population and 90% of injuries were within 45 minutes of either trauma center. The post-predicted volume of severely injured patients at the legacy center was 434, but the actual number was 809. For minor injuries (ISS £15), NBATS-2 predicted 581 vs. 1677 actual. CONCLUSION NBATS-2 failed to predict the post-period volume changes. Without a change in EMS destination guidelines, this finding was not surprising for severely injured patients. However, the 288% increase in volume of minor injuries was unexpected. NBATS-2 must be refined to assess the impact of local factors on patient volume.
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Affiliation(s)
| | | | | | | | | | - Martin A Croce
- 4285University of Tennessee Health Science Center, TN, USA
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Shammassian BH, Wooster L, Wright JM, Kelly ML. Systematic review of trauma system regionalization and implementation on outcomes in traumatic brain injury patients. Neurol Res 2020; 43:87-96. [PMID: 32967585 DOI: 10.1080/01616412.2020.1824391] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND The number of trauma systems has increased dramatically within the United States over the past 40 years. The implementation of these systems has contributed to a decrease in mortality and improved outcomes in patients with trauma. Several studies have evaluated the effect of implementation of these systems on outcomes, but few studies examine the effects of such systems specifically on traumatic brain injury (TBI). METHODS A systematic review of the literature was conducted according the guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to determine the effects of trauma system implementation and regionalization on mortality and other outcome measures in adult TBI. We sought to include both experimental and observational studies within the United States. RESULTS From 1983 to 2015, nine studies were identified that adhered to the predefined inclusion and exclusion criteria representing six different geographic areas within the United States. All studies utilized a retrospective pre-post implementation methodology. A variety of mortality outcome measures were identified in the literature. Six of the nine studies demonstrated some benefit on various mortality metrics. CONCLUSION The existing literature on the effects of trauma system implementation or regionalization on outcomes in TBI is sparse but overall seems to convey an improvement in mortality.
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Affiliation(s)
- Berje H Shammassian
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center , Cleveland, OH, USA.,Case Western Reserve University School of Medicine , Cleveland, OH, USA
| | - Luke Wooster
- Case Western Reserve University School of Medicine , Cleveland, OH, USA
| | - James M Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center , Cleveland, OH, USA.,Case Western Reserve University School of Medicine , Cleveland, OH, USA
| | - Michael L Kelly
- Case Western Reserve University School of Medicine , Cleveland, OH, USA.,Department of Neurological Surgery, MetroHealth Medical Center , Cleveland, OH, USA
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Tignanelli CJ, Watarai B, Fan Y, Petersen A, Hemmila M, Napolitano L, Jarosek S, Charles A. Racial Disparities at Mixed-Race and Minority Hospitals : Treatment of African American Males With High-Grade Splenic Injuries. Am Surg 2020; 87:287-295. [PMID: 32931304 DOI: 10.1177/0003134820947369] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries. METHODS Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation. RESULTS Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.
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Affiliation(s)
| | - Bradly Watarai
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yunhua Fan
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mark Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lena Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Kool B, Lilley R, Davie G, de Graaf B, Reid P, Branas C, Civil I, Dicker B, Ameratunga SN. Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study. Inj Prev 2020; 27:injuryprev-2019-043408. [PMID: 32447305 DOI: 10.1136/injuryprev-2019-043408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/19/2020] [Accepted: 04/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand. METHODS A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009-2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25-49) and non-survivable (ISS >49). RESULTS Of the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. 'Non-survivable' injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15-29 year. The majority of 'survivable' cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care. DISCUSSION In New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.
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Affiliation(s)
- Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pararangi Reid
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ian Civil
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Dicker
- Paramedicine Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Sharwood LN, Wiseman T, Tseris E, Curtis K, Vaikuntam B, Craig A, Young J. Pre-existing mental disorder, clinical profile, inpatient services and costs in people hospitalised following traumatic spinal injury: a whole population record linkage study. Inj Prev 2020; 27:injuryprev-2019-043567. [PMID: 32414771 DOI: 10.1136/injuryprev-2019-043567] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/06/2020] [Accepted: 04/19/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Risk of traumatic injury is increased in individuals with mental illness, substance use disorder and dual diagnosis (mental disorders); these conditions will pre-exist among individuals hospitalised with acute traumatic spinal injury (TSI). Although early intervention can improve outcomes for people who experience mental disorders or TSI, the incidence, management and cost of this often complex comorbid health profile is not sufficiently understood. In a whole population cohort of patients hospitalised with acute TSI, we aimed to describe the prevalence of pre-existing mental disorders and compare differences in injury epidemiology, costs and inpatient allied health service access. METHODS Record linkage study of all hospitalised cases of TSI between June 2013 and June 2016 in New South Wales, Australia. TSI was defined by specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. Mental disorder status was considered as pre-existing where specific ICD-10-AM codes were recorded in incident admissions. RESULTS 13 489 individuals sustained acute TSI during this study. 13.11%, 6.06% and 1.82% had pre-existing mental illness, substance use disorder and dual diagnosis, respectively. Individuals with mental disorder were older (p<0.001), more likely to have had a fall or self-harmed (p<0.001), experienced almost twice the length of stay and inpatient complications, and increased injury severity compared with individuals without mental disorder (p<0.001). CONCLUSION Individuals hospitalised for TSI with pre-existing mental disorder have greater likelihood of increased injury severity and more complex, costly acute care admissions compared with individuals without mental disorder. Care pathway optimisation including prevention of hospital-acquired complications for people with pre-existing mental disorders hospitalised for TSI is warranted.
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Affiliation(s)
- Lisa Nicole Sharwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Engineering and Risk, University of Technology Sydney, Sydney, NSW, Australia
| | - Taneal Wiseman
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Tseris
- Faculty of Arts and Social Sciences, Sydney School of Education and Social work, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Bharat Vaikuntam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashley Craig
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- National Drug Research Institute, Curtin University, Perth, WA, Australia
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Yuma P, Orsi R, Dunn JA, Kenyon V, Tulanowski E, Stallones L. Traumatic injury and access to care in rural areas: leveraging linked data and geographic information systems for planning and advocacy. Rural Remote Health 2019; 19:5089. [PMID: 31510753 DOI: 10.22605/rrh5089] [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] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The purpose of this ecological study was to apply Geographic Information System (GIS) methods to patterns of traumatic injury and access to trauma care to facilitate system planning and advocacy. METHODS Four US state (Colorado) and national data sources were linked to examine county-level disparities. Average ambulance drive times to trauma centers for populated places in each county were estimated and mapped. RESULTS Independent samples t-tests demonstrated Colorado's rural counties had significantly higher injury hospitalization rates (mean (M)=685.4 v M=566.3; p=0.005)) and fatality rates (M=93.8 v M=71.6, p<0.001), indicating residents with the least access to care are the most impacted by the burden of injury; this finding was supported by GIS analyses of drive times to level I and II trauma centers and underlying injury rates, which are visually displayed. CONCLUSIONS These methods are useful tools for rural public health professionals to conduct system optimization, identify training and resource needs, assess prevention priorities, and advocate for trauma system support.
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Affiliation(s)
- Paula Yuma
- School of Social Work and School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Rebecca Orsi
- School of Social Work and School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Julie A Dunn
- Acute Care Surgery, University of Colorado Health, Suite 360, 2500 Rocky Mountain Ave, Loveland, CO, USA
| | - Victoria Kenyon
- Social Work Research Center, Colorado State University, Fort Collins, CO, USA
| | - Elizabeth Tulanowski
- Warner College of Natural Resources and Geospatial Centroid, Colorado State University, Fort Collins, CO, USA
| | - Lorann Stallones
- Department of Psychology, Injury Control Research Center and School of Public Health, Colorado State University, Fort Collins, CO, USA
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Wang NE, Newton CR, Spain DA, Pirrotta E, Thomas-Uribe M. Patient, hospital and regional characteristics associated with undertriage of injured children in California (2005-2015): a retrospective cohort study. Trauma Surg Acute Care Open 2019; 4:e000317. [PMID: 31565676 PMCID: PMC6744082 DOI: 10.1136/tsaco-2019-000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVE Trauma centers save lives, but they are scarce and concentrated in urban settings. The population of severely injured children in California who do not receive trauma center care (undertriage) is not well understood. METHODS Retrospective observational study of all children (0-17 years) hospitalized for severe trauma in California (2005-2015). We used the California Office of Statewide Health Planning and Development linked Emergency Department and Inpatient Discharge data sets. Logistic regression models were created to analyze characteristics associated with undertriage. The model was clustered on differential distance between distance from residence to primary triage hospital and distance from residence to nearest trauma center. We controlled for body part injured, injury type, intent and year. The a priori hypothesis was that uninsured and publicly insured children and hospitals and regions with limited resources would be associated with undertriage. RESULTS Twelve percent (1866/15 656) of children with severe injury experienced undertriage. Children aged >14 years compared with 0-13 years had more than 2.5 times the odds of undertriage (OR 2.58; 95% CI 2.1 to 3.16). Children with private Health Maintenance Organization (HMO) insurance compared with public insurance had 13 times the odds of undertriage (OR 12.62; 95% CI 8.95 to 17.79). Hospitals with >400 compared with <200 beds had more than three times the odds of undertriage (OR 3.64; 95% CI 2.6 to 5.11). Urban versus suburban residence had 1.3 times increased odds of undertriage (OR 1.31; 95% CI 1.02 to 1.67) Undertriage volume was largest in urban areas. CONCLUSION Undertriage is associated with private HMO insurance, primary triage to large hospitals and urban residence. Understanding the characteristics associated with undertriage can help improve trauma systems. LEVEL OF EVIDENCE Level III (non-experimental retrospective observational study).
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Affiliation(s)
- N. Ewen Wang
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher R. Newton
- Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | | | - Elizabeth Pirrotta
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Monika Thomas-Uribe
- Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
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Abstract
Trauma management in Australia is predominantly that of blunt mechanism trauma spread across a geographically large and sparsely populated country. A complex network of patient care has evolved to manage major trauma. Over recent decades, focus has been given to improving and co-ordinating transfer of patients into major trauma centers and improved data collection with the corresponding improved patient outcomes. This article provides an overview of the nature and structure of the Australian trauma system and its regulation.
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Affiliation(s)
| | - Chris Morrey
- Orthopaedic and Trauma Unit, Cairns Hospital and James Cook University, Carins, QLD
| | | | | | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
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Ashley DW, Pracht EE, Garlow LE, Medeiros RS, Atkins EV, Johns TJ, Ferdinand CH, Dente CJ, Dunne JR, Nicholas JM. Evaluation of the Georgia trauma system using the American College of Surgeons Needs Based Assessment of Trauma Systems tool. Trauma Surg Acute Care Open 2018; 3:e000188. [PMID: 30402557 PMCID: PMC6203137 DOI: 10.1136/tsaco-2018-000188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022] Open
Abstract
Background The American College of Surgeons Needs Based Assessment of Trauma Systems (NBATS) tool was developed to help determine the optimal regional distribution of designated trauma centers (DTC). The objectives of our current study were to compare the current distribution of DTCs in Georgia with the recommended allocation as calculated by the NBATS tool and to see if the NBATS tool identified similar areas of need as defined by our previous analysis using the International Classification of Diseases, Ninth Revision, Clinical Modification Injury Severity Score (ICISS). Methods Population counts were acquired from US Census publications. Transportation times were estimated using digitized roadmaps and patient zip codes. The number of severely injured patients was obtained from the Georgia Discharge Data System for 2010 to 2014. Severely injured patients were identified using two measures: ICISS<0.85 and Injury Severity Score >15. Results The Georgia trauma system includes 19 level I, II, or III adult DTCs. The NBATS guidelines recommend 21; however, the distribution differs from what exists in the state. The existing DTCs exactly matched the NBATS recommended number of level I, II, or III DTCs in 2 of 10 trauma service areas (TSAs), exceeded the number recommended in 3 of 10 TSAs, and was below the number recommended in 5 of 10 TSAs. Densely populated, or urban, areas tend to be associated with a higher number of existing centers compared with the NBATS recommendation. Other less densely populated TSAs are characterized by large rural expanses with a single urban core where a DTC is located. The identified areas of need were similar to the ones identified in the previous gap analysis of the state using the ICISS methodology. Discussion The tool appears to underestimate the number of centers needed in extensive and densely populated areas, but recommends additional centers in geographically expansive rural areas. The tool signifies a preliminary step in assessing the need for state-wide inpatient trauma center services. Level of evidence Economic, level IV.
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Affiliation(s)
| | | | | | | | | | - Tracy J Johns
- The Medical Center, Navicent Health, Macon, Georgia, USA
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Khajanchi MU, Kumar V, Wärnberg Gerdin L, Soni KD, Saha ML, Roy N, Gerdin Wärnberg M. Prevalence of a definitive airway in patients with severe traumatic brain injury received at four urban public university hospitals in India: a cohort study. Inj Prev 2018; 25:428-432. [PMID: 29866716 DOI: 10.1136/injuryprev-2018-042826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/27/2018] [Accepted: 05/19/2018] [Indexed: 01/10/2023]
Abstract
AIM To estimate the proportion of patients arriving with a Glasgow Coma Scale (GCS) less than 9 who had a definitive airway placed prior to arrival. METHODS We conducted a retrospective analysis of the data from a multicentre, prospective observational research project entitled Towards Improved Trauma Care Outcomes in India. Adults aged ≥18 years with an isolated traumatic brain injury (TBI) who were transferred from another hospital to the emergency department of the participating hospital with a GCS less than 9 were included. Our outcome was a definitive airway, defined as either intubation or surgical airway, placed prior to arrival at a participating centre. RESULTS The total number of patients eligible for this study was 1499. The median age was 40 years and 84% were male. Road traffic injuries and falls comprised 88% of the causes of isolated TBI. The number of patients with GCS<9 who had a definitive airway placed before reaching the participating centres was 229. Thus, the proportion was 0.15 (95% CI 0.13 to 0.17). The proportions of patients with a definitive airway who arrived after 24 hours (19%) were approximately double the proportion of patients who arrived within 6 hours (10%) after injury to the definitive care centre. CONCLUSION The rates of definitive airway placement are poor in adults with an isolated TBI who have been transferred from another health facility to tertiary care centres in India.
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Affiliation(s)
- Monty Uttam Khajanchi
- Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Vineet Kumar
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | | | - Kapil Dev Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Center, AIIMS (ND), New Delhi, India
| | - Makhan Lal Saha
- Department of General Surgery, Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Nobhojit Roy
- WHO Collaborating Centre for research on Surgical care delivery in LMICs, Surgical Unit, BARC Hospital (Govt. of India) , Mumbai, India.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
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Shaw BI, Wangara AA, Wambua GM, Kiruja J, Dicker RA, Mweu JM, Juillard C. Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage. Trauma Surg Acute Care Open 2017; 2:e000130. [PMID: 29766119 PMCID: PMC5887833 DOI: 10.1136/tsaco-2017-000130] [Citation(s) in RCA: 7] [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: 09/22/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background Road traffic injuries (RTIs) are a cause of significant morbidity and mortality in low- and middle-income countries. Access to timely emergency services is needed to decrease the morbidity and mortality of RTIs and other traumatic injuries. Our objective was to describe the distribution of roadtrafficcrashes (RTCs) in Nairobi with the relative distance and travel times for victims of RTCs to health facilities with trauma surgical capabilities. Methods RTCs in Nairobi County were recorded by the Ma3route app from May 2015 to October 2015 with latitude and longitude coordinates for each RTC extracted using geocoding. Health facility administrators were interviewed to determine surgical capacity of their facilities. RTCs and health facilities were plotted on maps using ArcGIS. Distances and travel times between RTCs and health facilities were determined using the Google Maps Distance Matrix API. Results 89 percent (25/28) of health facilities meeting inclusion criteria were evaluated. Overall, health facilities were well equipped for trauma surgery with 96% meeting WHO Minimal Safety Criteria. 76 percent of facilities performed greater than 12 of three pre-selected ‘Bellweather Procedures’ shown to correlate with surgical capability. The average travel time and distance from RTCs to the nearest health facilities surveyed were 7 min and 3.4 km, respectively. This increased to 18 min and 9.6 km if all RTC victims were transported to Kenyatta National Hospital (KNH). Conclusion Almost all hospitals surveyed in the present study have the ability to care for trauma patients. Treating patients directly at these facilities would decrease travel time compared with transfer to KNH. Nairobi County could benefit from formally coordinating the triage of trauma patients to more facilities to decrease travel time and potentially improve patient outcomes. Level of evidence III
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Affiliation(s)
- Brian I Shaw
- School of Medicine, University of California, San Francisco, California, USA
| | - Ali Akida Wangara
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Jason Kiruja
- Department of Pediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Rochelle A Dicker
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California, USA
| | | | - Catherine Juillard
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California, USA
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Avraham JB, Bhandari M, Frangos SG, Levine DA, Tunik MG, DiMaggio CJ. Epidemiology of paediatric trauma presenting to US emergency departments: 2006-2012. Inj Prev 2017; 25:136-143. [PMID: 29056586 DOI: 10.1136/injuryprev-2017-042435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 04/17/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Traumatic injury is the leading cause of paediatric morbidity and mortality in the USA. We present updated national data on emergency department (ED) discharges for traumatic injury for a recent 7-year period. METHODS We conducted a descriptive epidemiological analysis of the Nationwide Emergency Department Sample Survey, the largest and most comprehensive database in the USA, for 2006-2012. Among children and adolescents, we tracked changes in injury mechanism and severity, cost of care, injury intent and the role of trauma centres. RESULTS There was an 8.3% (95% CI 7.7 to 8.9) decrease in the annual number of ED visits for traumatic injury in children and adolescents over the study period, from 8 557 904 (SE=5861) in 2006 to 7 846 912 (SE=5191) in 2012. The case-fatality rate was 0.04% for all injuries and 3.2% for severely injured children. Children and adolescents with high-mortality injury mechanisms were more than three times more likely to be treated at a level 1 trauma centre (OR=3.5, 95% CI 3.3 to 3.7), but were more no more likely to die (OR=0.96, 95% CI 0.93 to 1.00). Traumatic brain injury diagnoses increased 22.2% (95% CI 20.6 to 23.9) during the study period. Intentional assault accounted for 3% (SE=0.1) of all child and adolescent ED injury discharges and 7.2% (SE=0.3) of discharges among 15-19 year-olds. There was an 11.3% (95% CI 10.0 to 12.6) decline in motor vehicle injuries from 2009 to 2012. The total cost of care was $23 billion (SE=0.01), a 78% increase from 2006 to 2012. CONCLUSIONS This analysis presents a recent portrait of paediatric trauma across the USA. These analyses indicate the important role and value of trauma centre care for injured children and adolescents, and that the most common causes and mechanisms of injury are preventable.
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Affiliation(s)
- Jacob B Avraham
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Misha Bhandari
- Department of Surgery, New York University School of Medicine, New York City, New York, USA.,Department of Emergency Medicine, New York Presbyterian, The University Hospital of Columbia and Cornell, New York, NY
| | - Spiros G Frangos
- Department of Surgery, Division of Acute Care and Trauma Surgery, New York University School of Medicine/Bellevue Hospital Center, New York City, New York, USA
| | - Deborah A Levine
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York City, New York, USA.,Ronald O Perelman Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center, New York City, New York, USA
| | - Michael G Tunik
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York City, New York, USA.,Ronald O Perelman Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center, New York City, New York, USA
| | - Charles J DiMaggio
- Department of Surgery, Division of Acute Care and Trauma Surgery, New York University School of Medicine/Bellevue Hospital Center, New York City, New York, USA.,Population Health, New York University School of Medicine, New York, NY, USA
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Hayre J, Rouse C, French J, Fraser J, Watson I, Benjamin S, Chisholm A, Stoica G, Sealy B, Erdogan M, Green R, Atkinson P. A traumatic tale of two cities: a comparison of outcomes for adults with major trauma who present to differing trauma centres in neighbouring Canadian provinces. CAN J EMERG MED 2018; 20:191-9. [PMID: 28703089 DOI: 10.1017/cem.2017.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES While the use of formal trauma teams is widely promoted, the literature is not clear that this structure provides improved outcomes over emergency physician delivered trauma care. The goal of this investigation was to examine if a trauma team model with a formalized, specialty-based trauma team, with specific activation criteria and staff composition, performs differently than an emergency physician delivered model. Our primary outcome was survival to discharge or 30 days. METHODS An observational registry-based study using aggregate data from both the New Brunswick and Nova Scotia trauma registries was performed with data from April 1, 2011 to March 31, 2013. Inclusion criteria included patients 16 years-old and older who had an Injury Severity Score greater than 12, who suffered a kinetic injury and arrived with signs of life to a level-1 trauma centre. RESULTS 266 patients from the trauma team model and 111 from the emergency physician model were compared. No difference was found in the primary outcome of proportion of survival to discharge or 30 days between the two systems (0.88, n=266 vs. 0.89, n=111; p=0.8608). CONCLUSIONS We were unable to detect any difference in survival between a trauma team and an emergency physician delivered model.
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Bulger EM, Kastl JG, Maier RV. The history of Harborview Medical Center and the Washington State Trauma System. Trauma Surg Acute Care Open 2017; 2:e000091. [PMID: 29766093 PMCID: PMC5877906 DOI: 10.1136/tsaco-2017-000091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/16/2017] [Accepted: 06/05/2017] [Indexed: 12/03/2022] Open
Abstract
Harborview Medical Center serves as the sole adult and pediatric level I trauma center for Washington State, and its faculty have led efforts to develop comprehensive systems of trauma care across the country. The Washington State trauma system is an inclusive system that was developed based on data-driven decisions to distribute resources based on population need. This article seeks to explore the history of Harborview Medical Center and the development of the Washington State trauma system to identify the guiding principles and lessons learned, which can facilitate system development for a host of time-sensitive medical conditions.
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Affiliation(s)
- Eileen M Bulger
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Janet Griffith Kastl
- Washington State Department of Health, Office of EMS and Trauma, Olympia, Washington, USA
| | - Ronald V Maier
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
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36
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Rice A, Dudek J, Gross T, St Mars T, Woolridge D. The Impact of a Pediatric Emergency Department Facility Verification System on Pediatric Mortality Rates in Arizona. J Emerg Med 2017; 52:894-901. [PMID: 28341087 DOI: 10.1016/j.jemermed.2017.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/08/2016] [Revised: 02/02/2017] [Accepted: 02/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Emergency Medical Services for Children State Partnership Program, as well as the Institute of Medicine report on pediatric emergency care, encourages recognition of emergency departments (EDs) through categorization and verification systems. Although pediatric verification programs are associated with greater pediatric readiness, clinical outcome data have been lacking to track the effects and patient-centered outcomes by implementing such programs. OBJECTIVE To describe pediatric mortality rates prior to and after implementation of a pediatric emergency facility verification system in Arizona. METHODS This was a cross-sectional study conducted using data from ED visits between 2011 and 2014 recorded in the Arizona Hospital Discharge Database. The primary outcome measure was the mortality rate for ED visits by patients under 18 years old. Rates were compared prior to and after facility certification by the Arizona Pediatric Prepared Emergency Care program. RESULTS The total number of ED visits by children during the study period was 1,928,409. Of these, 1,127,294 were at facilities undergoing certification. For hospitals becoming certified, overall ED mortality rates were 35.2 deaths/100,000 ED visits (95% confidence interval [CI] 29.5-41.7) in the precertification analysis and 34.4 deaths/100,000 ED visits (95% CI 30.4-38.9) in the postcertification analysis. The injury-related ED visit mortality rate for certified hospitals showed a decrease from 40.0 injury-related deaths/100,000 ED visits (95% CI 28.6-54.4) in the precertification analysis to 25.8 injury-related deaths/100,000 ED visits (95% CI 18.7-34.8) in the postcertification analysis. CONCLUSION The implementation of the Arizona pediatric ED verification system was associated with a trend toward lower mortality. These results offer a platform for further research on pediatric ED preparedness efforts and their effects on improved patient outcomes.
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Affiliation(s)
- Amber Rice
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Toni Gross
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
| | - Tomi St Mars
- Arizona Department of Health Services, Phoenix, Arizona
| | - Dale Woolridge
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona; Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
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Kiragu AW, Dunlop SJ, Wachira BW, Saruni SI, Mwachiro M, Slusher T. Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward. J Pediatr Intensive Care 2016; 6:52-59. [PMID: 31073425 DOI: 10.1055/s-0036-1584676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/07/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
Traumatic injuries are a significant cause of death and disability worldwide. The vast majority of these injuries occur in low- and middle-income countries (LMICs). Attention to protocolized care and adaptations to treatments based on availability of resources, regionalization of care, and the development of centers of excellence within each LMIC are crucial to improving outcomes and lowering trauma-related morbidity and mortality worldwide. Given limitations in the availability of the resources necessary to provide the levels of care found in high-income countries, strategies to prevent trauma and make the best use of available resources when prevention fails, and thus achieve the best possible outcomes for injured and critically ill children, are vital. Overall, a commitment on the part of governments in LMICs to the provision of adequate health care services to their populations will improve the outcomes of injured children. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W Kiragu
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Medicine, University of Minnesota, Minneapolis, Minnesota, United States
| | - Benjamin W Wachira
- Accident and Emergency Department, Aga Khan University Hospital, Nairobi, Kenya
| | - Seno I Saruni
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | | | - Tina Slusher
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
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Abstract
Management of severely injured patients is complex and requires organised, expert care. Regionalised trauma systems are relatively new in the UK and aim to deliver optimal, timely care to injured patients at the most appropriate location. This article discusses the drivers, organisation, processes and outcomes of regionalised trauma care. It also describes the challenges and benefits of working within a trauma system to enable emergency practitioners to reflect on their roles in contemporary trauma care.
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Affiliation(s)
- Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London
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Agrawal A, Coronado VG, Bell JM, Baisakhiya N, Kakani A, Galwankar S, Dwivedi S. Characteristics of patients who died from traumatic brain injury in two rural hospital emergency departments in Maharashtra, India, 2007-2009. Int J Crit Illn Inj Sci 2015; 4:293-7. [PMID: 25625060 PMCID: PMC4296331 DOI: 10.4103/2229-5151.147521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Trauma is one of the leading causes of morbidity and mortality in the world and in India. Objective: To describe 1) selected epidemiological and clinical characteristics of persons with traumatic brain injury (TBI) who died within 24 h after admission to the emergency departments (EDs) of two medical facilities in rural India and 2) the methods used to transport these patients from the locale of the injury incident to the study sites. Materials and Methods: Medical records of all injured patients regardless of age or sex who died within 24 h after admission to both EDs during January 31, 2007 through December 31, 2009 were reviewed and abstracted. Demographic variables and information on prehospital care, time and mechanism of injury, mode of transport to EDs, and primary hospital resuscitation were abstracted and analyzed. Results: Of the 113 injured patients in this study, 42 had TBI and died within 24 h of ED admission. All of these TBI patients were transported to the ED by relatives or bystanders in non-ambulance vehicles. Most of the patients with TBI (78.5%) were 21-50-years-old; and overall 90.0% were males. Persons working near or along busy roads struck by vehicles accounted for 80.9% of all TBI cases. Severe TBIs were present in 97.6% of the patients; of these, 92.8% had a Glasgow Coma Scale (GCS) score of 3 on arrival. Other concurrent injuries included superficial lacerations (85.7%), facial injuries (57.1%), and upper (35.7%) and lower (30.9%) extremity fractures. Common lesions recognized on computed tomography (CT) scan were acute subdural hematoma (21.4%), subarachnoid hemorrhage with diffuse cerebral edema (16.6%), and skull base fracture with diffuse cerebral edema (14.2%); in 21.4% of cases, the CT scan were reported normal. Conclusion: Most of the TBI patients who died within 24 h after admission to EDs in this study were not transported to EDs in emergency medical vehicles; most were of working age (ages 20-50 years); were male; and were day laborers working on busy interstate roads where they were hit by vehicles.
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Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, Narayana Medical College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India
| | - Victor G Coronado
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA, United States
| | - Jeneita M Bell
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA, United States
| | - Nitish Baisakhiya
- Maharshi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Anand Kakani
- Datta Meghe Institute of Medical Sciences, Acharaya Vinoba Bhave Rural Hospital, Sawangi, Maharashtra, India
| | - Sagar Galwankar
- Maharshi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Sankalp Dwivedi
- Maharshi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Butler B, Agubuzu O, Hansen L, Crandall M. Illinois trauma centers and community violence resources. J Emerg Trauma Shock 2014; 7:14-9. [PMID: 24550624 PMCID: PMC3912644 DOI: 10.4103/0974-2700.125633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/11/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Elder abuse and neglect (EAN), intimate partner violence (IPV), and street-based community violence (SBCV) are significant public health problems, which frequently lead to traumatic injury. Trauma centers can provide an effective setting for intervention and referral, potentially interrupting the cycle of violence. Aims: To assess existing institutional resources for the identification and treatment of violence victims among patients presenting with acute injury to statewide trauma centers. Settings and Design: We used a prospective, web-based survey of trauma medical directors at 62 Illinois trauma centers. Nonresponders were contacted via telephone to complete the survey. Materials and Methods: This survey was based on a survey conducted in 2004 assessing trauma centers and IPV resources. We modified this survey to collect data on IPV, EAN, and SBCV. Statistical Analysis: Univariate and bivariate statistics were performed using STATA statistical software. Results: We found that 100% of trauma centers now screen for IPV, an improvement from 2004 (P = 0.007). Screening for EAN (70%) and SBCV (61%) was less common (P < 0.001), and hospitals thought that resources for SBCV in particular were inadequate (P < 0.001) and fewer resources were available for these patients (P = 0.02). However, there was lack of uniformity of screening, tracking, and referral practices for victims of violence throughout the state. Conclusion: The multiplicity of strategies for tracking and referring victims of violence in Illinois makes it difficult to assess screening and tracking or form generalized policy recommendations. This presents an opportunity to improve care delivered to victims of violence by standardizing care and referral protocols.
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Affiliation(s)
- Bennet Butler
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ogo Agubuzu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luke Hansen
- Department of Hospital Medicine, Northwestern University, Chicago, IL, USA
| | - Marie Crandall
- Department of Surgery, Northwestern University, Chicago, IL, USA
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Abstract
BACKGROUND UK trauma services are currently undergoing reconfiguration, but the optimum management pathway for head-injured patients is uncertain. We therefore performed a systematic review to assess the effects of routine inter-hospital transfer and specialist neuroscience care on mortality and disability in patients with non-surgical severe traumatic brain injury injured nearest to a non-specialist acute hospital. METHODS A protocol was registered with PROSPERO (CRD42012002021) and review methodology followed Cochrane Collaboration recommendations. A peer reviewed search strategy was implemented in an exhaustive range of information sources, including all major bibliographic databases, between 1973 and July 2013. Selection of eligible studies, extraction of relevant data and bias assessment were then performed by two independent reviewers. In the absence of homogeneous effect estimates at low risk of bias a narrative synthesis was pre-specified. RESULTS Four cohort studies, including a total of 4688 patients, were identified as potentially eligible after screening and bias assessment. Confounding by indication, arising from selective transfer of less severely injured patients, was the main limitation of included studies, with overall risk of bias rated as high for both mortality and disability effect estimates. Adjusted odds ratios for mortality favoured secondary transfer, ranging from 1.92 (95% CI 1.25-2.95) to 2.09 (95% CI 1.59-2.74). No convincing association was observed between non-specialist care and unfavourable outcome with a conditional odds ratio of 1.13 (95% CI 0.36-3.6). CONCLUSIONS There is limited evidence supporting a strategy of secondary transfer of severe non-surgical traumatic brain injury patients to specialist neuroscience centres. Randomised controlled trials powered to detect clinically plausible treatment effects should be considered to definitively investigate effectiveness.
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Affiliation(s)
- Gordon Fuller
- Emergency Medicine Research in Sheffield, Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield , Sheffield , UK
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Taylor CB, Liu B, Bruce E, Burns B, Jan S, Myburgh J. Primary scene responses by Helicopter Emergency Medical Services in New South Wales Australia 2008-2009. BMC Health Serv Res 2012; 12:402. [PMID: 23152963 PMCID: PMC3507904 DOI: 10.1186/1472-6963-12-402] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 11/08/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite numerous studies evaluating the benefits of Helicopter Emergency Medical Services (HEMS) in primary scene responses, little information exists on the scope of HEMS activities in Australia. We describe HEMS primary scene responses with respect to the time taken, the distances travelled relative to the closest designated trauma hospital and the receiving hospital; as well as the clinical characteristics of patients attended. METHODS Clinical service data were retrospectively obtained from three HEMS in New South Wales between July 2008 and June 2009. All available primary scene response data were extracted and examined. Geographic Information System (GIS) based network analysis was used to estimate hypothetical ground transport distances from the locality of each primary scene response to firstly the closest designated trauma hospital and secondly the receiving hospital. Predictors of bypassing the closest designated trauma hospital were analysed using logistic regression. RESULTS Analyses included 596 primary missions. Overall the HEMS had a median return trip time of 94min including a median of 9min for activation, 34min travelling to the scene, 30min on-scene and 25min transporting patients to the receiving hospital. 72% of missions were within 100km of the receiving hospital and 87% of missions were in areas classified as 'major cities' or 'inner regional'. The majority of incidents attended by HEMS were trauma-related, with road trauma the predominant cause (44%). The majority of trauma patients (81%) had normal physiology at HEMS arrival (RTS = 7.84). We found 62% of missions bypassed the closest designated trauma hospital. Multivariate predictors of bypass included: age; presence of spinal or burns trauma; the level of the closest designated trauma hospital; the transporting HEMS. CONCLUSION Our results document the large distances travelled by HEMS in NSW, especially in rural areas. The high proportion of HEMS missions that bypass the closest designated trauma hospital is a seldom mentioned benefit of HEMS transport. These results along with the characteristics of patients attended and the time HEMS take to complete primary scene responses are useful in understanding the benefit HEMS provides and the services it replaces.
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Affiliation(s)
- Colman B Taylor
- The George Institute for Global Health, PO Box M201, Missenden Rd Camperdown, NSW 2050, Sydney, NSW, Australia
- The University of Sydney, Sydney Medical School, Sydney, NSW, Australia
| | - Bette Liu
- The University of NSW, Faculty of Medicine, Sydney, NSW, Australia
| | - Eleanor Bruce
- The University of Sydney, School of Geosciences, Sydney, NSW, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, Ambulance Service of NSW, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, PO Box M201, Missenden Rd Camperdown, NSW 2050, Sydney, NSW, Australia
| | - John Myburgh
- The George Institute for Global Health, PO Box M201, Missenden Rd Camperdown, NSW 2050, Sydney, NSW, Australia
- The University of NSW, Faculty of Medicine, Sydney, NSW, Australia
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