1
|
Carenzo L, Mercalli C, Reitano E, Tartaglione M, Ceolin M, Cimbanassi S, Del Fabbro D, Sammartano F, Cecconi M, Coniglio C, Chiara O, Gamberini L. State of the art of trauma teams in Italy: A nationwide study. Injury 2024; 55:111388. [PMID: 38316572 DOI: 10.1016/j.injury.2024.111388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
Trauma teams play a vital role in providing prompt and specialized care to trauma patients. This study aims to provide a comprehensive description of the presence and organization of trauma teams in Italy. A nationwide cross-sectional epidemiological study was conducted between July and October 2022, involving interviews with 137 designated trauma centers. Centers were stratified based on level: higher specialized trauma centers (CTS), intermediate level trauma centers (CTZ + N) and district general hospital with trauma capacity (CTZ). A standardized structured interview questionnaire was used to gather information on hospital characteristics, trauma team prevalence, activation pathways, structure, components, leadership, education, and governance. Descriptive statistics were used for analysis. Results showed that 53 % of the centers had a formally defined trauma team, with higher percentages in CTS (73 %) compared to CTZ + N (49 %) and CTZ (39 %). The trauma team activation pathway varied among centers, with pre-alerts predominantly received from emergency medical services. The study also highlighted the lack of formally defined massive transfusion protocols in many centers. The composition of trauma teams typically included airway and procedure doctors, nurses, and healthcare assistants. Trauma team leadership was predetermined in 59 % of the centers, with anesthesiologists/intensive care physicians often assuming this role. The study revealed gaps in trauma team education and governance, with a lack of specific training for trauma team leaders and low utilization of simulation-based training. These findings emphasize the need for improvements in trauma management education, governance, and the formalization of trauma teams. This study provides valuable insights that can guide discussions and interventions aimed at enhancing trauma care at both local and national levels in Italy.
Collapse
Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy.
| | - Cesare Mercalli
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Martina Ceolin
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Stefania Cimbanassi
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Daniele Del Fabbro
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Fabrizio Sammartano
- Department of Trauma Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20162, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Osvaldo Chiara
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| |
Collapse
|
2
|
Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, Baptista S, Mesquita C, Alexandrino H. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg 2023; 49:1771-1781. [PMID: 36414695 DOI: 10.1007/s00068-022-02166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
Collapse
Affiliation(s)
- André Bento
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Ferreira
- Department of General Surgery, Hospital Central do Funchal, SESARAM, Funchal, Portugal
| | - Carlos Yánez Benitez
- General and Gastrointestinal Surgery, Royo Villanova Hospital, SALUD, Zaragoza, Spain
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Piotr Kozera
- Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Sérgio Baptista
- Department of Anesthesiology, Centro Hospitalar do Médio Tejo, EPE, Tomar, Portugal
| | - Carlos Mesquita
- Head of Clinic (Consultancy in General and Emergency Surgery and Trauma), Private Practice Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
| |
Collapse
|
3
|
Tjardes T, Meyer LM, Lotz A, Defosse J, Hensen S, Hirsch P, Salge TO, Imach S, Klasen M, Stead S, Walossek N. [Application of artificial intelligence systems in the emergency room : Do the communication patterns give indications for possible starting points? An observational study]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01326-9. [PMID: 37273116 DOI: 10.1007/s00113-023-01326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND High expectations are currently attached to the application of artificial intelligence (AI) in the resuscitation room treatment of trauma patients with respect to the development of decision support systems. No data are available regarding possible starting points for AI-controlled interventions in resuscitation room treatment. OBJECTIVE Do information request behavior and quality of communication indicate possible starting points for AI applications in the emergency room? MATERIAL AND METHODS A 2‑stage qualitative observational study: 1. Development of an observation sheet based on expert interviews that depicts the following six relevant topics: situational factors (course of accident, environment), vital parameters, treatment-specific Information (treatment carried out). trauma-specific factors (injury patterns), medication, special features of the patient (anamnesis, etc.) 2. Observational study Which topics were inquired about during emergency room treatment? Was the exchange of information complete? RESULTS There were 40 consecutive observations in the emergency room. A total of 130 questions: 57/130 inquiries about medication/treatment-specific Information and vital parameters, 19/28 of which were inquiries about medication. Questions about injury-related parameters 31/130 with 18/31 regarding injury patterns, course of accident (8/31) and type of accident (5/31). Questions about medical or demographic background 42/130. Within this group, pre-existing illnesses (14/42) and demographic background (10/42) were the most frequently asked questions. Incomplete exchange of information was found in all six subject areas. CONCLUSION Questioning behavior and incomplete communication indicate a cognitive overload. Assistance systems that prevent cognitive overload can maintain decision-making abilities and communication skills. Which AI methods can be used requires further research.
Collapse
Affiliation(s)
- Thorsten Tjardes
- Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland.
- Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln Merheim, Kliniken der Stadt Köln gGmbH, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
| | - Lea Mareen Meyer
- Institut für Technologie und Innovationsmanagement (TIM), Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Anna Lotz
- Klinik für Anästhesiologie und operative Intensivmedizin, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Jerome Defosse
- Klinik für Anästhesiologie und operative Intensivmedizin, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Sandra Hensen
- Institut für Psychologie, Kognitions- und Experimentalpsychologie, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Patricia Hirsch
- Institut für Psychologie, Kognitions- und Experimentalpsychologie, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Torsten Oliver Salge
- Institut für Technologie und Innovationsmanagement (TIM), Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Sebastian Imach
- Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Martin Klasen
- AIXTRA Kompetenzzentrum für Training und Patientensicherheit, Aachen, Deutschland
| | - Susan Stead
- Institut für Technologie und Innovationsmanagement (TIM), Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Nina Walossek
- Klinik für Anästhesiologie und operative Intensivmedizin, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| |
Collapse
|
4
|
Emergency medicine (EM) can safely manage geriatric trauma patients sustaining ground level falls: Fostering EM autonomy while safely offloading a busy trauma service. Am J Surg 2022; 224:1314-1318. [DOI: 10.1016/j.amjsurg.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
|
5
|
AKDENİZ S, OKUR MH, GÖYA C. Künt Karaciğer Travmalı Hastaların Demografik, Klinik ve Laboratuvar Sonuçları: 2006-2016 Yıllarının Retrospektif İncelemesi. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
|
7
|
Erdogan M, Kureshi N, Karim SA, Tallon JM, Asbridge M, Green RS. Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre. BMJ Open 2018; 8:e024190. [PMID: 30429147 PMCID: PMC6252682 DOI: 10.1136/bmjopen-2018-024190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing. DESIGN Retrospective cohort study. SETTING Tertiary trauma centre in Halifax, Canada. PARTICIPANTS 2306 trauma patients who required activation of the trauma team. PRIMARY OUTCOME MEASURE The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing. RESULTS Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend. CONCLUSIONS At this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.
Collapse
Affiliation(s)
- Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Nelofar Kureshi
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Saleema A Karim
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John M Tallon
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert S Green
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
8
|
Hong ZJ, Chen CJ, Chan DC, Chen TW, Yu JC, Hsu SD. Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries. Surg Today 2018; 49:261-267. [PMID: 30302552 DOI: 10.1007/s00595-018-1723-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/29/2018] [Indexed: 11/25/2022]
Abstract
The trauma team leader is a professional who receives and treats trauma patients. We aimed to evaluate whether or not the seniority of a qualified trauma team leader was a prognostic factor for multiple-trauma patients managed by a trauma team. This was a retrospective cohort study conducted at a Level I Trauma Center in North Taiwan. From January 2009 to December 2013, 284 patients were randomly assigned to one of two trauma team leaders (junior and senior leaders) on duty, irrespective of the seniority of the qualified trauma team leader. All parameters were collected and compared between these two groups. In the subgroup of multiple-trauma patients with Glasgow Coma Scale (GCS) ≤ 8, there were significant differences in the injury severity score, revised trauma score, and seniority of the leader between the alive and dead groups. A multivariate logistic regression analysis showed that the seniority of the trauma team leader was an important mortality risk factor [odds ratio (OR): 14.529, 95% confidence interval (CI) 1.683-125.429, p = 0.015] in patients with GCS ≤ 8. However, in patients with GCS > 8, age was the only independent risk factor [OR: 1.055, 95% CI 1.023-1.087, p = 0.001]. The seniority of the qualified trauma leader is important for teamwork, organization, and efficiency, all of which play an important role in improving the survival outcome of patients with GCS ≤ 8.
Collapse
Affiliation(s)
- Zhi-Jie Hong
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cheng-Jueng Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - De-Chuan Chan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Teng-Wei Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sheng-Der Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. .,Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. .,Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec 2, Chen-Kung Rd, Neihu 114, Taipei, Taiwan, ROC.
| |
Collapse
|
9
|
Allen B, Callaway D, Gibbs M, Noste E, West K, Johnson MA, Caro D, Godwin A. Regarding the Joint Statement From the American College of Surgeons Committee on Trauma and the American College of Emergency Physicians Regarding the Clinical Use of Resuscitative Endovascular Balloon Occlusion of the Aorta. J Emerg Med 2018; 55:266-268. [PMID: 29937072 DOI: 10.1016/j.jemermed.2018.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Bryant Allen
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - David Callaway
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Gibbs
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Erin Noste
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Kathryn West
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - M Austin Johnson
- Department of Emergency Medicine, University of California-Davis Medical Center, Sacramento, California
| | - David Caro
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida
| | - Andrew Godwin
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida
| |
Collapse
|
10
|
Butler MB, Erdogan M, Green RS. Effect of an Emergency Medicine Resident as Team Leader on Outcomes of Trauma Team Activations. AEM EDUCATION AND TRAINING 2018; 2:107-114. [PMID: 30051077 PMCID: PMC6001507 DOI: 10.1002/aet2.10082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/09/2017] [Accepted: 12/20/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Traditionally, a surgeon has served as trauma team leader (TTL). However, this role is increasingly being performed by emergency medicine (EM) physicians. At the Halifax Infirmary, we utilize a resident TTL (rTTL) under supervision of a staff traumatologist, a duty shared between EM and surgical residents. Our objective was to compare outcomes between cases led by EM and surgical rTTLs. METHODS This was a retrospective case-control study of data collected from the Nova Scotia Trauma Registry. Eligible cases were attended to by the trauma team from April 4, 2014, to March 31, 2015. Primary outcome of interest was in-hospital mortality. Secondary outcomes included hospital admission, hospital length of stay (LOS), intensive care unit (ICU) admission, ICU LOS, ventilator requirement, operating room use, and time to operating room. Univariate comparisons were made using t-tests and Fisher's test. We used logistic and linear regression to adjust for confounding. RESULTS A total of 571 patients were included in the analysis. A total of 179 (31.3%) were managed by an EM resident and the remainder were managed by a surgical resident. There was no statistical difference in mortality or secondary outcomes on the crude or adjusted estimates. Eighteen patients (10.1%) in the EM group died compared to 37 (9.4%) in the surgical group. CONCLUSIONS There was no difference in any patient outcome between cases managed by EM and surgical rTTLs. These findings support the philosophy that both groups are effective as rTTLs and should be trained in trauma leadership. Further research is warranted in introducing the rTTL into other systems.
Collapse
Affiliation(s)
| | - Mete Erdogan
- Trauma Nova ScotiaNova Scotia Department of Health and WellnessHalifaxNSCanada
| | - Robert S. Green
- Department of Critical CareDalhousie UniversityHalifaxNSCanada
- Trauma Nova ScotiaNova Scotia Department of Health and WellnessHalifaxNSCanada
| |
Collapse
|
11
|
Allen BK, Callaway DW, Gibbs M, Noste E, West K, Johnson MA, Caro D, Godwin A. Regarding the 'Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)'. Trauma Surg Acute Care Open 2018; 3:e000168. [PMID: 29767642 PMCID: PMC5887825 DOI: 10.1136/tsaco-2018-000168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/19/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Bryant K Allen
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - David W Callaway
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael Gibbs
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Erin Noste
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kathryn West
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - M Austin Johnson
- Department of Emergency Medicine, University of California - Davis, Davis, California, USA
| | - David Caro
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| | - Andy Godwin
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| |
Collapse
|
12
|
Successful Interprofessional Approach to Development of a Resuscitative Endovascular Balloon Occlusion of the Aorta Program at a Community Trauma Center. J Emerg Med 2018; 54:419-426. [PMID: 29456087 DOI: 10.1016/j.jemermed.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/21/2017] [Accepted: 01/06/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a relatively innovative procedure designed to control critical non-compressible torso hemorrhage. In the United States, this procedure is currently in active use at only a small number of trauma centers. OBJECTIVE We describe how we developed our REBOA program at an independent academic-affiliated community trauma center. DISCUSSION Through a close interprofessional and multidisciplinary collaboration led by emergency physicians and trauma surgeons, we were able to successfully develop our program. CONCLUSIONS Successful implementation of a REBOA program requires close attention to multimodal training, interprofessional roles, team dynamics, financial considerations, and quality assurance processes to safely deliver this potentially life-saving procedure to our trauma patient population.
Collapse
|
13
|
Zimmerman SA, Reed CS, Reed AN, Jones RJ, Chard A, Reed DN. Extending surgeon response times in tier 2 traumas does not adversely affect patient outcomes. J Surg Res 2018; 226:24-30. [PMID: 29661285 DOI: 10.1016/j.jss.2017.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/18/2017] [Accepted: 12/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of a trauma surgeon during patient resuscitations is required at most American College of Surgeons-verified trauma centers despite little evidence showing improved patient outcomes in the less-than-critically injured (Tier 2) trauma patients. This study was designed to identify the impact of extending required surgeon response times on outcomes in tier 2 trauma patients. METHODS An American College of Surgeons-verified level 2 trauma center extended the maximum allowed surgeon response time for tier 2 activations from 60 min to 120 min on November 1, 2011. Surgeon response time and patient outcomes of the retrospective control group (January 1, 2008-October 31, 2011) were then compared with the prospective test group (November 1, 2011-December 31, 2014). Primary outcomes included mortality and hospital length of stay (HLOS). Secondary outcomes were emergency department length of stay, and time from ED arrival to CT scan. A subset analysis of all patients evaluated by a surgeon within 60 min of arrival versus those evaluated by a surgeon after 60 min was also performed. RESULTS The control and test groups were composed of 757 and 792 patients, and their mean injury severity score was 9.0 and 6.0, respectively. Emergency department length of stay showed a statistically significant increase of 12 min, whereas HLOS was unchanged throughout the study. Mortality was not significantly different between the groups. Subset analysis revealed a median surgeon arrival time of 15 min in the <60-min group and 85 min in the >60-min group, whereas the injury severity score, HLOS, and mortality were not significantly different between these subsets. No correlation existed between these outcomes and surgeon arrival time. CONCLUSIONS Doubling required surgeon response time in tier 2 trauma patients does not produce negative outcomes in this patient group. Mandatory surgeon response times in similar patient groups can be re-evaluated to allow for greater flexibility of a limited surgeon workforce while still providing safe care.
Collapse
Affiliation(s)
| | - Christopher S Reed
- Department of Surgery, Indiana University School of Medicine, Fort Wayne, Indiana
| | | | - Ronald J Jones
- Department of Surgery, Lutheran Hospital of Indiana, Fort Wayne, Indiana
| | - Annette Chard
- Department of Surgery, Lutheran Hospital of Indiana, Fort Wayne, Indiana
| | - Donald N Reed
- Department of Surgery, Indiana University School of Medicine, Fort Wayne, Indiana
| |
Collapse
|
14
|
Qasim ZA, Sikorski RA. Physiologic Considerations in Trauma Patients Undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta. Anesth Analg 2017. [PMID: 28640785 DOI: 10.1213/ane.0000000000002215] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resuscitative endovascular balloon occlusion of the aorta is a new procedure for adjunctive management of critically injured patients with noncompressible torso or pelvic hemorrhage who are in refractory hemorrhagic shock, ie, bleeding to death. The anesthesiologist plays a critical role in management of these patients, from initial evaluation in the trauma bay to definitive care in the operating room and the critical care unit. A comprehensive understanding of the effects of resuscitative endovascular balloon occlusion of the aorta is essential to making it an effective component of hemostatic resuscitation.
Collapse
Affiliation(s)
- Zaffer A Qasim
- From the *Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware; and †Department of Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | | |
Collapse
|
15
|
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 2017; 20:191-199. [PMID: 28703089 DOI: 10.1017/cem.2017.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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.
Collapse
|
16
|
Is it safe to admit patients with acute injuries to nonsurgical services? A retrospective review. Am J Surg 2017; 213:1098-1103. [DOI: 10.1016/j.amjsurg.2016.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/15/2016] [Accepted: 04/26/2016] [Indexed: 11/21/2022]
|
17
|
Variability in CT imaging of blunt trauma among ED physicians, surgical residents, and trauma surgeons. J Surg Res 2017; 213:6-15. [PMID: 28601333 DOI: 10.1016/j.jss.2017.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/16/2016] [Accepted: 02/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Trauma triage decisions can be influenced by both knowledge and experience. Consequently, there may be substantial variability in computed tomography (CT) scans desired by emergency medicine physicians, surgical chief residents, and attending trauma surgeons. We quantified this difference and studied the effects of each group's decisions on missed injuries, cost, and radiation exposure. METHODS All blunt trauma activations at an urban level 1 trauma center were studied over a 6-mo period. Three months into the study, a pan-scan protocol was introduced. Prior to CT imaging, providers separately completed a survey that asked which CT scans were desired for each patient. Based on the completed surveys, hypothetical missed injuries, radiation exposure, and cost were determined. RESULTS The variability in the number of CT scans desired by each of the three providers and the resulting cost and radiation exposure were not statistically significant. Substantial variability was predominantly seen in the indications for the desired scans, with the difference between proportions ranging from 3.1%-68.7%. Agreement among the three providers was highest for head and c-spine scans (80%-100%) and lowest for maxillary face (57%-80%) and chest scans (52%-74%). Overall, the missed injury rate was similar for all the providers; chief residents missed significantly more major injuries than trauma attendings during the pan-scan period (P = 0.03). CONCLUSIONS Trauma training and level of training did not have a substantial effect on radiological decisions during the initial trauma assessment. This study sheds light on the growing uniformity among providers with regard to medical decision-making in the initial work-up of trauma.
Collapse
|
18
|
Hajibandeh S, Hajibandeh S. Who should lead a trauma team: Surgeon or non-surgeon? A systematic review and meta-analysis. J Inj Violence Res 2017; 9:107-116. [PMID: 28513531 PMCID: PMC5556626 DOI: 10.5249/jivr.v9i2.874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/24/2017] [Indexed: 11/06/2022] Open
Abstract
Background: Presence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS) guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data. Results: Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03). Conclusions: Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare the effectiveness of surgeon and non-surgeon trauma team leaders in order to resolve the controversy about who should lead the trauma team. Clinically significant missed injuries should be considered as important outcome in future studies.
Collapse
Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Manchester, UK.
| | | |
Collapse
|
19
|
In view of standardization: Comparison and analysis of initial management of severely burned patients in Germany, Austria and Switzerland. Burns 2015; 41:33-8. [DOI: 10.1016/j.burns.2014.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/29/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022]
|
20
|
|
21
|
Abstract
The introduction of trauma teams has improved patient outcome independently. The aim of establishing a trauma team is to ensure the early mobilization and involvement of more experienced medical staff and thereby to improve patient outcome. The team approach allows for distribution of the several tasks in assessment and resuscitation of the patient in a 'horizontal approach', which may lead to a reduction in time from injury to critical interventions and thus have a direct bearing on the patient's ultimate outcome. A trauma team leader or supervisor, who coordinates the resuscitation and ensures adherence to guidelines, should lead the trauma team. There is a major national and international variety in trauma team composition, however crucial are a surgeon, an Emergency Medicine physician or both and anaesthetist. Advanced Trauma Life Support training, simulation-based training, and video review have all improved patient outcome and trauma team performance. Developments in the radiology, such as the use of computed tomography scanning in the emergency room and the endovascular treatment of bleeding foci, have changed treatment algorithms in selected patients. These developments and new insights in shock management may have a future impact on patient management and trauma team composition.
Collapse
Affiliation(s)
- D Tiel Groenestege-Kreb
- Department of Trauma, University Medical Centre Utrecht (UMCU), HP G04·228, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - O van Maarseveen
- Department of Trauma, University Medical Centre Utrecht (UMCU), HP G04·228, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - L Leenen
- Department of Trauma, University Medical Centre Utrecht (UMCU), HP G04·228, PO Box 85500, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
22
|
|
23
|
Harrois A, Hamada S, Laplace C, Duranteau J, Vigué B. The initial management of severe trauma patients at hospital admission. ACTA ACUST UNITED AC 2013; 32:483-91. [PMID: 23910065 DOI: 10.1016/j.annfar.2013.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The initial management of trauma patient is a critical period aiming at: stabilizing the vital functions; following a rigorous injury assessment; defining a therapeutic strategy. This management has to be organized to minimize loss of time that would be deleterious for the patients outcome. Thus, before patient arrival, the trauma team alert should lead to the initiation of care procedures adapted to the announced severity of the patient. Moreover, each individual should know its role in advance and the team should be managed by only one individual (the trauma leader) to avoid conflicts of decision. A rapid trauma injury assessment aims not only at guiding resuscitation (chest drainage, pelvic contention, to define the mean arterial pressure goal) but also to decide a critical intervention in case of hemodynamic instability (laparotomy, thoracotomy, arterial embolisation). This initial assessment includes a chest and a pelvic X-ray, abdominal ultrasound (extended to the lung) and transcranial Doppler (TCD). The whole body scanner with administration of intravenous contrast material is the cornerstone of the injury assessment but can be done for patients stabilized after the initial resuscitation.
Collapse
Affiliation(s)
- A Harrois
- Département d'anesthésie-réanimation chirurgicale, université Paris-Sud, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, Assistance publique-Hôpitaux de Paris, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | | | | | | | | |
Collapse
|
24
|
Hunt DLS, Berg GM, Zackula RE, Ekengren FH, Lippoldt D, Ablah E, Wetta R. Treatment provider is most predictive of ED dismissal in minimally-injured trauma patients: a retrospective review. J Trauma Manag Outcomes 2013; 7:5. [PMID: 23680170 PMCID: PMC3673816 DOI: 10.1186/1752-2897-7-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/06/2013] [Indexed: 11/22/2022]
Abstract
Background Secondary triage protocols have been described in the literature as physiologic (first-tier) criteria and mechanism-related (second-tier) criteria to determine the level of trauma activation. There is debate as to the efficiency of triage decisions based on mechanism of injury which may result in overtriage and overuse of limited trauma resources. Our institution developed and implemented an advanced three-tier trauma alert system in which stable patients presenting with blunt traumatic mechanism of injury would be evaluated by the emergency department (ED) physician rather than the trauma surgeon. The American College of Surgeons Committee on Trauma (ACSCOT) requires that operational changes be monitored and evaluated for patient safety and performance. The primary aim of this study was to evaluate the process, as well as outcomes, of patient care pre and post implementation of the new triage protocol. The secondary aim was to determine predictor variables that were associated with ED dismissal. Methods A retrospective blinded pre/post process change implementation explicit chart review was conducted to compare process and outcomes of minimally injured trauma patients who were field triaged by mechanism of injury. Generalized linear modeling was performed to determine which predictor variables were associated with ED dismissal. Results There were no significant differences in minutes to physician evaluation, CT scan, OR/ICU disposition, readmission rates, safety or quality. Significant differences only occurred in time to chest x-ray, length of stay in ED, and ED dismissal rates. Trauma surgeon and ED physician patient groups did not differ on ISS, age, or sex. The only significant predictor for ED dismissal was treatment provider, with ED physicians 3.6 times more likely to dismiss the patient from the emergency department. Conclusions ED physicians provided compble care as measured by safety, timeliness, and quality in minimally-injured patients triaged to our trauma center based only on mechanism of injury. Moreover, ED physicians were more likely to dismiss patients from the ED. A three-tiered internal triaging protocol can redirect resource usage to reduce the burden on the trauma service. This may be increasingly beneficial in trauma models in which the trauma surgeons also serve as critical care intensivists.
Collapse
|
25
|
Lillebo B, Seim A, Vinjevoll OP, Uleberg O. What is optimal timing for trauma team alerts? A retrospective observational study of alert timing effects on the initial management of trauma patients. J Multidiscip Healthc 2012; 5:207-13. [PMID: 22973111 PMCID: PMC3430097 DOI: 10.2147/jmdh.s33740] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Trauma teams improve the initial management of trauma patients. Optimal timing of trauma alerts could improve team preparedness and performance while also limiting adverse ripple effects throughout the hospital. The purpose of this study was to evaluate how timing of trauma team activation and notification affects initial in-hospital management of trauma patients. Methods Data from a single hospital trauma care quality registry were matched with data from a trauma team alert log. The time from patient arrival to chest X-ray, and the emergency department length of stay were compared with the timing of trauma team activations and whether or not trauma team members received a preactivation notification. Results In 2009, the trauma team was activated 352 times; 269 times met the inclusion criteria. There were statistically significant differences in time to chest X-ray for differently timed trauma team activations (P = 0.003). Median time to chest X-ray for teams activated 15–20 minutes prearrival was 5 minutes, and 8 minutes for teams activated <5 minutes before patient arrival. Timing had no effect on length of stay in the emergency department (P = 0.694). We found no effect of preactivation notification on time to chest X-ray (P = 0.474) or length of stay (P = 0.684). Conclusion Proactive trauma team activation improved the initial management of trauma patients. Trauma teams should be activated prior to patient arrival.
Collapse
Affiliation(s)
- Borge Lillebo
- Norwegian EHR Research Centre, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | |
Collapse
|
26
|
Cohen R, Adini B, Radomislensky I, Givon A, Rivkind AI, Peleg K. Involvement of surgical residents in the management of trauma patients in the emergency room: does the presence of an attending physician affect outcomes? World J Surg 2012; 36:539-47. [PMID: 22270994 DOI: 10.1007/s00268-012-1428-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Few studies have investigated whether the presence or absence of attending physicians (AP) in the emergency department (ED) during the management of trauma patients by residents. METHODS Six level 1 trauma center admissions for years 2006-2008 were analyzed to determine whether presence of an AP affected the time spent in the ED, post-ED disposition, and in-hospital mortality. RESULTS Patient demographics differed in relation to the presence of APs (P < 0.01). Patients with ISS > 25 who died during hospitalization were more often managed when APs were present. Male patients, those <65, and patients with Injury Severity Score (ISS) > 16 were more often treated in the presence of an AP (P < 0.01). Penetrating, terror trauma, motor vehicle collision and assaults were more often managed in the presence APs. Presence of APs differed by hospital (P < 0.0001). Adjusted logistic regression revealed that patients spent less time in the ED, went directly to the operating room or the ICU for definitive care, if an AP was present. CONCLUSIONS Presence of an attending physician improved and focused patient triage, disposition decisions, and outcomes.
Collapse
Affiliation(s)
- Robert Cohen
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, Israel.
| | | | | | | | | | | |
Collapse
|
27
|
Gokdemir MT, Sogut O, Kaya H, Sayhan MB, Cevik M, Dokuzoglu MA, Boleken ME. Role of Oxidative Stress in the Clinical Outcome of Patients with Multiple Blunt Trauma. J Int Med Res 2012; 40:167-73. [DOI: 10.1177/147323001204000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: This prospective study evaluated serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI), along with the Revised Trauma Score (RTS) and Injury Severity Score (ISS), as predictors of clinical outcome in the early post-traumatic period in patients with multiple blunt trauma (MBT). METHODS: The study included 52 patients admitted to the emergency department with MBT and 40 age-and sex-matched healthy control subjects. RESULTS: The overall MBT patient mortality was 32.7% (17/52). There was no significant association between age and mortality in MBT patients, but there was a negative correlation between mortality and RTS, and a positive correlation between mortality and ISS. TOS levels were significantly higher in nonsurvivors compared with survivors. There was no correlation between TAS or OSI and survival. ISS and RTS showed positive and negative correlations with TOS level, respectively, but neither was significantly related to TAS or OSI. CONCLUSIONS: These findings suggest that TOS, as an early oxidative stress biomarker, may be an objective alternative criterion to the ISS and RTS for managing patients with MBT during the early period following traumatic injury.
Collapse
Affiliation(s)
- MT Gokdemir
- Department of Emergency Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - O Sogut
- Department of Emergency Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - H Kaya
- Department of Emergency Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - MB Sayhan
- Department of Emergency Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - M Cevik
- Department of Paediatric Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - MA Dokuzoglu
- Department of Emergency Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - ME Boleken
- Department of Paediatric Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| |
Collapse
|
28
|
Tai MCK, Cheng RCH, Rainer TH. Trauma systems: Do trauma teams make a difference? TRAUMA-ENGLAND 2011. [DOI: 10.1177/1460408611405294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review describes the various components of a trauma team, and emphasises its value as one of many parts of a trauma system. The evidence for the team is weak and based on expert opinion and experience. Nevertheless, the evidence that high quality trauma systems improve survival, and that a trauma team is a vital component of all such systems is compelling. There is no evidence that a particular component of the team is essential. The trauma team is likely to have most impact on patients with moderate severity of trauma and probability of survival.
Collapse
Affiliation(s)
- Marcus C-K Tai
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Raymond C-H Cheng
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Timothy H Rainer
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| |
Collapse
|
29
|
|
30
|
Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L, Anderson PD, Clem K. The efficacy and value of emergency medicine: a supportive literature review. Int J Emerg Med 2011; 4:44. [PMID: 21781295 PMCID: PMC3158547 DOI: 10.1186/1865-1380-4-44] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 07/22/2011] [Indexed: 11/10/2022] Open
Abstract
Study objectives The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established. Methods The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included. Results A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles). Conclusion There is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.
Collapse
Affiliation(s)
- C James Holliman
- The Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, and George Washington University School of Medicine and Health Sciences, Bethesda, MD, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Green SM. Trauma is occasionally a surgical disease: how can we best predict when? Ann Emerg Med 2011; 58:172-177.e1. [PMID: 21658803 DOI: 10.1016/j.annemergmed.2011.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 04/08/2011] [Accepted: 04/25/2011] [Indexed: 11/28/2022]
|
32
|
Georgiou A, Lockey DJ. The performance and assessment of hospital trauma teams. Scand J Trauma Resusc Emerg Med 2010; 18:66. [PMID: 21144035 PMCID: PMC3017008 DOI: 10.1186/1757-7241-18-66] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/13/2010] [Indexed: 11/10/2022] Open
Abstract
The purpose of the trauma team is to provide advanced simultaneous care from relevant specialists to the seriously injured trauma patient. When functioning well, the outcome of the trauma team performance should be greater than the sum of its parts. Trauma teams have been shown to reduce the time taken for resuscitation, as well as time to CT scan, to emergency department discharge and to the operating room. These benefits are demonstrated by improved survival rates, particularly for the most severely injured patients, both within and outside of dedicated trauma centres. In order to ensure the best possible performance of the team, the leadership skills of the trauma team leader are essential and their non-technical skills have been shown to be particularly important. Team performance can be enhanced through a process of audit and assessment of the workings of the team and the evidence currently available suggests that this is best facilitated through the process of video review of the trauma resuscitation. The use of human patient simulators to train and assess trauma teams is becoming more commonplace and this technique offers a safe environment for the future education of trauma team staff. Trauma teams are a key component of most programmes which set out to improve trauma care. This article reviews the background of trauma teams, the evidence for benefit and potential techniques of performance assessment. The review was written after a PubMed, Ovid, Athens, Cochrane and guideline literature review of English language articles on trauma teams and their performance and hand searching of references from the relevant searched articles.
Collapse
|
33
|
Alted López E. Pro Centros de Trauma. Med Intensiva 2010; 34:188-93. [DOI: 10.1016/j.medin.2009.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 11/16/2009] [Accepted: 11/18/2009] [Indexed: 02/03/2023]
|
34
|
Katsaragakis S, Drimousis PG, Kleidi ES, Toutouzas K, Lapidakis E, Papadakis G, Daskalakis K, Larentzakis A, Theodoraki ME, Theodorou D. Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality. Scand J Trauma Resusc Emerg Med 2010; 18:14. [PMID: 20233409 PMCID: PMC2855516 DOI: 10.1186/1757-7241-18-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 03/16/2010] [Indexed: 01/28/2023] Open
Abstract
Background Quality assessment of any trauma system involves the evaluation of the transferring patterns. This study aims to assess interfacility transfers in the absence of a formal trauma system setting and to estimate the benefits from implementing a more organized structure. Methods The 'Report of the Epidemiology and Management of Trauma in Greece' is a one year project of trauma patient reporting throughout the country. It provided data concerning the patterns of interfacility transfers. We compared the transferred patient group to the non transferred patient group. Information reviewed included patient and injury characteristics, need for an operation, Intensive Care Unit (ICU) admittance and mortality. Analysis employed descriptive statistics and Chi-square test. Interfacility transfers were then assessed according to each health care facility's availability of five requirements; Computed Tomography scanner, ICU, neurosurgeon, orthopedic and vascular surgeon. Results Data on 8,524 patients were analyzed; 86.3% were treated at the same facility, whereas 13.7% were transferred. Transferred patients tended to be younger, male, and more severely injured than non transferred patients. Moreover, they were admitted to ICU more often, had a higher mortality rate but were less operated on compared to non transferred patients. The 34.3% of transfers was from facilities with none of the five requirements, whereas the 12.4% was from those with one requirement. Low level facilities, with up to three requirements transferred 43.2% of their transfer volume to units of equal resources. Conclusion Trauma management in Greece results in a high number of transfers. Patients are frequently transferred between low level facilities. Better coordination could lead to improved outcomes and less cost.
Collapse
Affiliation(s)
- Stylianos Katsaragakis
- First Department of Propaedeutic Surgery, Surgical Intensive Care Unit, Hippocration General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Grossman MD, Portner M, Hoey BA, Schwab CW. Acute care surgeons and emergency traumatologists: a partnership for patient care. J Am Coll Surg 2010; 210:118-20. [PMID: 20123344 DOI: 10.1016/j.jamcollsurg.2009.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
|
36
|
|
37
|
The role of emergency medicine physicians in trauma care in North America: evolution of a specialty. Scand J Trauma Resusc Emerg Med 2009; 17:37. [PMID: 19698160 PMCID: PMC2741427 DOI: 10.1186/1757-7241-17-37] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 08/23/2009] [Indexed: 11/23/2022] Open
Abstract
The role of Emergency Medicine Physicians (EMP) in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.
Collapse
|
38
|
Grossman MD, Portner M, Hoey BA, Stehly CD, Schwab C, Stoltzfus J. Emergency Traumatologists as Partners in Trauma Care: The Future Is Now. J Am Coll Surg 2009; 208:503-9. [DOI: 10.1016/j.jamcollsurg.2009.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/02/2009] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
|
39
|
Salottolo K, Slone DS, Howell P, Settell A, Bar-Or R, Craun M, Bar-Or D. Effects of a nonsurgical hospitalist service on trauma patient outcomes. Surgery 2009; 145:355-61. [PMID: 19303983 DOI: 10.1016/j.surg.2008.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The American College of Surgeons criteria for Level I trauma centers calls for >90% of trauma patients to be admitted directly by a trauma surgeon or surgical subspecialist; however, the efficiency of the trauma system may be increased if patients presenting with comorbid conditions and minor injuries are treated by a hospitalist team (nonsurgical Trauma MEDical [TMED] service). We hypothesized outcomes would be equivalent for patients treated under TMED versus a surgical service. METHODS This retrospective review compared mortality, hospital length of stay (LOS), Emergency Department (ED) LOS, placement to rehabilitation facilities, and complication rates for patients who could have been treated by TMED as identified by an algorithm. The study population for 2003 (pre-TMED) was compared with the study population for 2006 (post-TMED). Univariate analyses and multivariate logistic and linear regression were used to identify outcomes that were different for patients treated in 2003 versus 2006. Sensitivity, specificity, and percent kappa agreement were calculated for patients who were treated by the TMED team in 2006 versus patients in 2006 who were identified using the algorithm. RESULTS The algorithm had reasonable sensitivity (78%) and specificity (90%); the kappa agreement was excellent (0.88). No differences were found in mortality (P = .31), rate of complications (P = .08), ED LOS (P = .77), or placement to rehabilitation facilities (P = .29) for patients identified in 2003 versus 2006. Hospital LOS was increased in 2006 (3.7 vs 4.1 days; P = .02). CONCLUSION These data support admission of trauma patients with nonsevere, single-system injuries to a nonsurgical hospitalist service. We hypothesize that overall system efficiency may be improved by applying this alternative model in other trauma centers.
Collapse
Affiliation(s)
- Kristin Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, CO 80113, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
In terms of cost and years of potential lives lost, injury arguably remains the most important public health problem facing the United States. Care of traumatically injured patients depends on early surgical intervention and avoiding delays in the diagnosis of injuries that threaten life and limb. In the critical care phase, successful outcomes after injury depend almost solely on diligence, attention to detail, and surveillance for iatrogenic infections and complications.
Collapse
Affiliation(s)
- Hugo Bonatti
- University of Virginia School of Medicine, 1215 Lee Street, Charlottesville, VA 22908, USA
| | | |
Collapse
|
41
|
Green SM. Trauma surgery: discipline in crisis. Ann Emerg Med 2008; 53:198-207. [PMID: 18439724 DOI: 10.1016/j.annemergmed.2008.03.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 03/20/2008] [Accepted: 03/26/2008] [Indexed: 11/18/2022]
Abstract
Throughout the past quarter century, there have been slow but dramatic changes in the nature and practice of trauma surgery, and this field increasingly faces potent economic, logistic, political, and workforce challenges. Patients and emergency physicians have much to lose by this budding crisis in our partner discipline. This article reviews the specific issues confronting trauma surgery, their historical context, and the potential directions available to this discipline. Implications of these issues for emergency physicians and for trauma care overall are discussed.
Collapse
Affiliation(s)
- Steven M Green
- Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA 92354, USA.
| |
Collapse
|
42
|
Green SM, Steele R. Mandatory surgeon presence on trauma patient arrival. Ann Emerg Med 2008; 51:334-5; author reply 335-8. [PMID: 18282532 DOI: 10.1016/j.annemergmed.2007.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 08/12/2007] [Accepted: 08/15/2007] [Indexed: 11/27/2022]
|
43
|
Pascual J, Sarani B, Schwab CW. Are Surgeons Superfluous To Initial Major Trauma Resuscitations? Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2007.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Ahmed JM, Tallon J, Petrie DA. Trauma management outcomes associated with nonsurgeon versus surgeon trauma. Ann Emerg Med 2008; 51:332-4; author reply 335-8. [PMID: 18282531 DOI: 10.1016/j.annemergmed.2007.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 08/09/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
|
45
|
Pascual J, Sarani B, Schwab CW. American College of Surgeons criteria for surgeon presence at initial trauma resuscitations: superfluous or necessary? Ann Emerg Med 2006; 50:15-7. [PMID: 17178171 DOI: 10.1016/j.annemergmed.2006.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 10/31/2006] [Accepted: 11/02/2006] [Indexed: 12/16/2022]
|