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Larsson G, Axelsson C, Hagiwara MA, Herlitz J, Klementsson H, Troëng T, Magnusson C. Epidemiology of patients assessed for trauma by Swedish ambulance services: a retrospective registry study. BMC Emerg Med 2024; 24:11. [PMID: 38191306 PMCID: PMC10775538 DOI: 10.1186/s12873-023-00924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/26/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND There is a lack of knowledge regarding the epidemiology of severe trauma assessed by Swedish emergency medical services (EMS). AIM To investigate the prevalence of trauma in Sweden assessed by EMS from a national perspective and describe patient demography, aetiology, trauma type, prehospital triage and clinical outcomes. METHODS Data from two national quality registries, the Swedish Ambulance Registry and the Swedish Trauma Registry (SweTrau) were collected from January 1 to December 31, 2019. Inclusion criteria were an Emergency Symptoms and Signs code equivalent to trauma in the Swedish Ambulance Registry and criteria fulfilled for SweTrau inclusion. Exclusion criteria were patients < 18 years old, those not transported to a hospital and those without a personal identification number. RESULTS In total, 53,120 patients with trauma were included (14% of primary EMS missions involving a personal identification number). Of those, 2,278 (4.3%) patients (median age: 45 years; 32% women) were reported in SweTrau to have severe or potentially severe trauma (penetrating: 7%, blunt: 93%). In terms of including all causes of trauma, the code for 'trauma alert activation' was most frequent (55%). The most frequent injury mechanism was an injury caused by a car (34%). Most (89%) cases were assigned Priority 1 (life-threatening condition) at the dispatch centre. 62% were regarded as potentially life threatening upon EMS arrival, whereas 29% were assessed as non-life-threatening. Overall, 25% of the patients had new injury severity scores > 15. 12% required invasive treatment, 11% were discharged with severe disability and the 30-day mortality rate was 3.6%. CONCLUSION In this cross-sectional study, 14% of the primary EMS missions for one year were caused by trauma. However, only a small proportion of these cases are severe injuries, and the risk of severe disabilities and death appears to be limited. The most frequent aetiology of a severe trauma is injury caused by a car, and most severe traumas are blunt. Severe traumas are given the highest priority at the dispatch centre in the vast majority of cases, but nearly one-third of these cases are considered a low priority by the EMS nurse. The latter leaves room for improvement.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
- PICTA, Prehospital Innovation Arena, Lindholmen Science Park, Gothenburg, Sweden.
| | - Christer Axelsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | - Johan Herlitz
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | | | | | - Carl Magnusson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Studer S, van Veelen NM, van de Wall BJM, Kuner V, Schrading S, Link BC, Knobe M, Babst R, Beeres FJP. Improving the protocol for whole-body CT scans in trauma patients. Eur J Trauma Emerg Surg 2022; 48:3149-3156. [PMID: 35088109 DOI: 10.1007/s00068-021-01862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE While whole-body computed tomography is an established diagnostic method for the work up of polytraumatized patients, the protocols used differ between trauma centers. This study aimed to compare scan duration and estimated radiation of two protocols. Secondary aim was to assess if using the revised CT protocol reduced the number of additional images of the upper extremities. METHODS Two groups of consecutive trauma patients, which both received a whole-body CT, were analyzed. Patients, who received a three-phased CT during which their arms needed to be repositioned from their side to above the head, were assigned to group A. Those, who received a CT with their arms placed on a pillow ventral to the abdomen throughout the entire scan were assigned to group B. Estimated radiation dose, scan duration, number of upper limb injuries and number of additional images of the upper limbs within 24 h after initial CT were assessed. RESULTS Group A consisted of 182 patients, group B of 218. The scan duration was 3 min shorter (p < 0.001) and the estimated radiation dose lower (15.0 vs 22.9 mSv, p < 0.001) in group B. There was no difference in the number of upper limb injuries detected or the number of upper limb additional images required within 24 h. CONCLUSION Using a whole-body CT scan protocol in which the arms remain on a pillow ventral to the torso instead of one which requires a repositioning of the arms, both scan duration and estimated radiation dose can be reduced. Despite the arms being within the scanned area in the revised protocol, the number of additional imaging of the upper extremities could not be reduced.
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Affiliation(s)
- Stephanie Studer
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
| | - Nicole Maria van Veelen
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland.
| | | | - Valerie Kuner
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
| | - Simone Schrading
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne 16, Switzerland
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Laplace C, Harrois A, Hamada S, Duranteau J. Traumatismes thoraciques non chirurgicaux. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Quintard H, Severac M, Martin C, Ichai C. In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals. Anaesth Crit Care Pain Med 2015; 34:225-30. [PMID: 26251399 DOI: 10.1016/j.accpm.2015.04.001] [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: 07/17/2014] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. MATERIAL AND METHOD A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. RESULTS Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. CONCLUSION This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices.
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Affiliation(s)
- Hervé Quintard
- Medicosurgical Unit, Saint-Roch Hospital, University Hospital of Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
| | - Mathilde Severac
- Medicosurgical Unit, Saint-Roch Hospital, University Hospital of Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - Claude Martin
- Anesthesiology-Emergency-Intensive Care Unit Department, Hospital Nord, University hospital of Aix-Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Carole Ichai
- Medicosurgical Unit, Saint-Roch Hospital, University Hospital of Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France; IRCAN (Inserm U1081, CNRS UMR7284), Nice-Sophia-Antipolis University, 06000 Nice, France
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Vardon F, Harrois A, Duranteau J, Geeraerts T. [The initial management in intensive care of pelvic ring injury patients]. ACTA ACUST UNITED AC 2014; 33:344-52. [PMID: 24833399 DOI: 10.1016/j.annfar.2014.03.008] [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: 01/15/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). It is therefore crucial to manage pelvic trauma in specialized trauma center. The initial trauma assessment aims to determine the role of the pelvic injury in hemorrhage to define the therapeutic strategy of pelvic trauma care (arterial embolisation/pelvic ring stabilisation). This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture.
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Affiliation(s)
- F Vardon
- Pôle anesthésie-réanimation, équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », université Toulouse 3 Paul-Sabatier, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 09, France
| | - A Harrois
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire de Bicêtre, hôpitaux universitaire Paris-Sud, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - J Duranteau
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire de Bicêtre, hôpitaux universitaire Paris-Sud, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - T Geeraerts
- Pôle anesthésie-réanimation, équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », université Toulouse 3 Paul-Sabatier, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 09, France.
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