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Woo J, Choi HZ, Kang J. Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea. Trauma Surg Acute Care Open 2024; 9:e001258. [PMID: 38779365 PMCID: PMC11110604 DOI: 10.1136/tsaco-2023-001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/09/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study investigated the characteristics and survival rates of patients with intentional severe trauma (self-harm or suicide) who were transported to either a regional trauma center (TC) or a non-TC facility. Methods This retrospective, national, population-based, observational, case-control study included patients who sustained intentional severe trauma and had an abnormal Revised Trauma Score at the injury site between January 2018 and December 2019. The data were a community-based severe trauma survey based on data collected from severe injury and multiple casualty patients transported by 119 emergency medical services (EMS), distributed by the Korea Disease Control and Prevention Agency. The treatment hospitals were divided into two types, TC and non-TCs, and several variables, including in-hospital mortality, were compared. Propensity score matching (PSM) was used to mitigate the influence of confounding variables on the survival outcomes. Results Among the 3864 patients, 872 and 2992 visited TC and non-TC facilities, respectively. The injury severity did not differ significantly between patients treated at TCs and non-TCs (TC, 9; non-TC, 9; p=0.104). However, compared with those treated at non-TCs, patients treated at TCs had a higher rate of surgery or transcatheter arterial embolization (14.2% vs 38.4%; p<0.001) and a higher admission rate to the emergency department (34.4% vs 60.6%; p<0.001). After PSM, 872 patients from both groups were analyzed. Patients treated at TCs exhibited a higher overall survival rate than those treated at non-TCs (76.1% vs 66.9%; p<0.001), and multiple variable logistic regression analysis demonstrated that the causes of injury and transport to the TC were significantly associated. Conclusion Using Korean EMS data, the results of this study revealed that initial transport to TCs was associated with reduced mortality rates. However, considering the limitations of using data from only 2 years and the retrospective design, further research is warranted. Study type Retrospective national, population-based observational case-control study. Level of evidence Level III.
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Affiliation(s)
- Jin Woo
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Korea (the Republic of)
| | - Han Zo Choi
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Korea (the Republic of)
| | - Jongkyeong Kang
- Department of Information Statistics, Kangwon National University, Chuncheon, Korea (the Republic of)
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Chervu NL, Butterfield J, Sakowitz S, Le N, Mallick S, Cho NY, Benharash P. Nationwide Trends in Utilization of Minimally Invasive Techniques for Blunt Abdominal Trauma. Am Surg 2024:31348241256065. [PMID: 38769751 DOI: 10.1177/00031348241256065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Despite increasing use of minimally invasive surgical (MIS) techniques for trauma, limited large-scale studies have evaluated trends, outcomes, and resource utilization at centers that utilize MIS modalities for blunt abdominal trauma. METHODS Operative adult admissions after blunt assault, falls, or vehicular collisions were tabulated from the 2016-2020 National Inpatient Sample. Patients who received diagnostic laparoscopy or other laparoscopic and robotic intervention were classified as MIS. Institutions with at least one MIS trauma operation in a year were defined as an MIS Performing Institution (MPI; rest: non-MPI). The primary endpoint was mortality, with secondary outcomes of reoperation, complication, postoperative length of stay (LOS), and hospitalization costs. Mixed regression models were used to determine the association of MPI status on the outcomes of interest. RESULTS Throughout the study period, the proportion of MIS operations and MPI significantly increased from 22.6 to 29.8% and 45.9 to 58.8%, respectively. Of an estimated 77,480 patients, 66.7% underwent care at MPI. After adjustment, MPI status was not associated with increased odds of mortality (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] [.96,1.24]), reoperation (AOR 1.02, CI [.87,1.19]), or any of the tabulated complications. There was additionally no difference in adjusted LOS (β-.18, CI [-.85, +.49]) or costs (β+$1600, CI [-1600, +4800]), between MPI and non-MPI. DISCUSSION The use of MIS operations in blunt abdominal trauma has significantly increased, with performing centers experiencing no difference in mortality or resource utilization. Prospectively collected data on outcomes following MIS trauma surgery is necessary to elucidate appropriate applications.
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Affiliation(s)
- Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jaron Butterfield
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nguyen Le
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nam Y Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Kliewer J, Luque I, Javier MA, Moorefield A, Mendez H, Martinez Z, Oster J, Rangel A, Morejón O. Emergency Surgical Treatment and Triage: Targeting Optimal Outcomes for Emergency Surgical Patients From Index Encounter Through Definitive Care. Am Surg 2024:31348241248783. [PMID: 38655840 DOI: 10.1177/00031348241248783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. METHODS A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. RESULTS 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. DISCUSSION Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.
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Affiliation(s)
- Jaclyn Kliewer
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
| | - Ilko Luque
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
| | - Mariel A Javier
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
| | | | - Hector Mendez
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
| | - Zulmari Martinez
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
| | - Jacob Oster
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
| | - Alexis Rangel
- Nursing Department, HCA Florida Kendall Hospital, Miami, FL, USA
| | - Orlando Morejón
- Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA
- Surgical Critical Care, HCA Florida Kendall Hospital, Miami, FL, USA
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Beiter KJ, Knowles SM, Tedesco A, Leonardi C, Scharf PL, Chapman BM, Brown TA, Schoen JE, Stuke LE, Greiffenstein PP, Marr AB, Hunt JP, Smith AA. Discrepancies in Mass Shootings and Access to Trauma Care Across the United States, 2014-2018. Am Surg 2024:31348241241748. [PMID: 38520302 DOI: 10.1177/00031348241241748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
INTRODUCTION The United States has one of the highest rates of gun violence and mass shootings. Timely medical attention in such events is critical. The objective of this study was to assess geographic disparities in mass shootings and access to trauma centers. METHODS Data for all Level I and II trauma centers were extracted from the American College of Surgeons and the Trauma Center Association of America registries. Mass shooting event data (4+ individuals shot at a single event) were taken from the Gun Violence Archive between 2014 and 2018. RESULTS A total of 564 trauma centers and 1672 mass shootings were included. Ratios of the number of mass shootings vs trauma centers per state ranged from 0 to 11.0 mass shootings per trauma center. States with the greatest disparity (highest ratio) included Louisiana and New Mexico. CONCLUSION States in the southern regions of the US experience the greatest disparity due to a high burden of mass shootings with less access to trauma centers. Interventions are needed to increase access to trauma care and reduce mass shootings in these medically underserved areas.
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Affiliation(s)
- Kaylin J Beiter
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Stacey M Knowles
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alexandra Tedesco
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Claudia Leonardi
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Peter L Scharf
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Brett M Chapman
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tommy A Brown
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jonathan E Schoen
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Lance E Stuke
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patrick P Greiffenstein
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alan B Marr
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John P Hunt
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Byskosh A, Shi M, Helenowski I, Holl JL, Hsia RY, Liepert AE, Mackersie RC, Stey AM. Is state trauma funding associated with mortality among injured hospitalized patients? Am J Surg 2024; 229:133-139. [PMID: 38155075 PMCID: PMC10998441 DOI: 10.1016/j.amjsurg.2023.12.011] [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: 08/24/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND We sought to quantify the association between state trauma funding and (1) in-hospital mortality and (2) transfers of injured patients. METHODS We conducted an observational cross-sectional study of states with publicly available trauma funding data. We analyzed in-hospital mortality using linked data from the Nationwide Inpatient Sample (NIS), American Hospital Association (AHA) Annual Survey, and these State Department of Public Health trauma funding data. RESULTS A total of 594,797 injured adult patients were admitted to acute care hospitals in 17 states. Patients in states with >$1.00 per capita state trauma funding had 0.82 (95 % CI: 0.78-0.85, p < 0.001) decreased adjusted odds of in-hospital mortality compared to patients in states with less than $1.00 per capita state trauma funding. CONCLUSIONS Increased state trauma funding is associated with decreased adjusted in-hospital mortality.
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Affiliation(s)
- Alexandria Byskosh
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Meilynn Shi
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Irene Helenowski
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, USA.
| | - Renee Y Hsia
- Department of Emergency Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA.
| | - Amy E Liepert
- Department of Surgery, School of Medicine, Marquette University, Columbia, MO, USA.
| | - Robert C Mackersie
- Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Aukstakalnis V, Stucinskas J, Dobozinskas P, Darginavicius L, Stasaitis K, Vaitkaitis D. Impact of video recordings review with structured debriefings on trauma team performance: a prospective observational cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02473-3. [PMID: 38393363 DOI: 10.1007/s00068-024-02473-3] [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: 12/14/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To determine the impact of structured debriefings (SD) with audio/video review of trauma patients' resuscitation events on trauma team (TT) technical and non-technical skills. METHODS Single-center prospective observational cohort study. The study included all emergency department patients aged 18 years or older who received resuscitation from the TT. Virtual meeting was held with the TT using SD to review one trauma patient resuscitation video. Technical skills improvement was based on adherence to the ATLS protocol and non-technical skills based on T-NOTECHS scale. RESULTS There was statistically significant improvement in adherence to the ATLS protocol: 73% [55-82%] vs 91% [82-100%] (p < 0.001); and improvement in T-NOTECHS scale: 12 [10-14] vs 16 [14-19] points (p < 0.001). CONCLUSION In this study, we found that structured debriefings with review of patients' resuscitation video recordings can have a significant positive impact on trauma team performance in the emergency department in both technical and non-technical skills.
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Affiliation(s)
- Vytautas Aukstakalnis
- Department of Emergency Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas, Lithuania.
| | - Justinas Stucinskas
- Department of Orthopaedics and Traumatology, Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas, Lithuania
| | - Paulius Dobozinskas
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas, Lithuania
| | - Linas Darginavicius
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas, Lithuania
| | - Kestutis Stasaitis
- Department of Emergency Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas, Lithuania
| | - Dinas Vaitkaitis
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, Kaunas, Lithuania
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Kim HW, Roh YS. Perceived trauma nursing core competency, interprofessional collaborative competency, and associated barriers among regional trauma center nurses. Int Emerg Nurs 2024; 72:101388. [PMID: 38134844 DOI: 10.1016/j.ienj.2023.101388] [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: 07/29/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION As key members of interprofessional teams working in complex settings, nurses in trauma centers require trauma nursing core competency. PURPOSE This study sought to determine the levels and relationships of the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers among Korean regional trauma center nurses. METHODS This cross-sectional, descriptive, and correlational survey involved a convenience sample of 190 Korean trauma center nurses. Data were collected using a web-based self-reporting questionnaire about the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple regression (Enter method) analyses. RESULTS The perceived performance and importance of interprofessional collaborative competency, the perceived importance of trauma nursing core competency, and the perceived barriers to resources, training, competency, and interest significantly affected trauma nursing core competency performance, accounting for 64.5 % of the variance. CONCLUSIONS Training programs are needed to improve the core and interprofessional collaborative competencies of trauma nurses. Individual, team, and organizational approaches are essential to addressing the perceived barriers. The effects of training programs on the core competency of trauma nurses should be validated.
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Affiliation(s)
- Hyo-Won Kim
- Graduate School of Nursing & Health Sciences, Chung-Ang University, Seoul, Republic of Korea
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul 06974, Republic of Korea.
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MacKechnie MC, Shearer DW, Verhofstad MHJ, Martin C, Graham SM, Pesantez R, Schuetz M, Hüttl T, Kojima K, Bernstein BP, Miclau T. Establishing Consensus on Essential Resources for Musculoskeletal Trauma Care Worldwide: A Modified Delphi Study. J Bone Joint Surg Am 2024; 106:47-55. [PMID: 37708306 DOI: 10.2106/jbjs.23.00387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Despite evidence that formalized trauma systems enhance patient functional outcomes and decrease mortality rates, there remains a lack of such systems globally. Critical to trauma systems are the equipment, materials, and supplies needed to support care, which vary in availability regionally. The purpose of the present study was to identify essential resources for musculoskeletal trauma care across diverse resource settings worldwide. METHODS The modified Delphi method was utilized, with 3 rounds of electronic surveys. Respondents consisted of 1 surgeon with expertise in musculoskeletal trauma per country. Participants were identified with use of the AO Trauma, AO Alliance, Orthopaedic Trauma Association, and European Society for Trauma and Emergency Surgery networks. Respondents rated resources on a Likert scale from 1 (most important) to 9 (least important). The "most essential" resources were classified as those rated ≤2 by ≥75% of the sampled group. RESULTS One hundred and three of 111 invited surgeons completed the first survey and were included throughout the subsequent rounds (representing a 93% response rate). Most participants were fellowship-trained (78%) trauma and orthopaedic surgeons (90%) practicing in an academic setting (62%), and 46% had >20 years of experience. Respondents represented low-income and lower-middle-income countries (LMICs; 35%), upper-middle income countries (UMICs; 30%), and high-income countries (HICs; 35%). The initial survey identified 308 unique resources for pre-hospital, in-hospital, and post-hospital phases of care, of which 71 resources achieved consensus as the most essential. There was a significant difference (p < 0.0167) in ratings between income groups for 16 resources, all of which were related to general trauma care rather than musculoskeletal injury management. CONCLUSIONS There was agreement on a core list of essential musculoskeletal trauma care resources by respondents from LMICs, UMICs, and HICs. All significant differences in resource ratings were related to general trauma management. This study represents a first step toward establishing international consensus and underscores the need to prioritize resources that are locally available. The information can be used to develop effective guidelines and policies, create best-practice treatment standards, and advocate for necessary resources worldwide. CLINICAL RELEVANCE This study utilized the Delphi method representing expert opinion; however, this work did not examine patient management and therefore does not have a clinical Level of Evidence.
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Affiliation(s)
- Madeline C MacKechnie
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - David W Shearer
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Simon M Graham
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom
| | - Rodrigo Pesantez
- Department of Orthopedic Surgery, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, Colombia
| | - Michael Schuetz
- Queensland University of Technology, Herston, Queensland, Australia
| | | | - Kodi Kojima
- Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Brian P Bernstein
- Division of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Theodore Miclau
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
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Lee A, Romano K, Tansley G, Al-Khaboori S, Thiara S, Garraway N, Finlayson G, Kanji HD, Isac G, Ta KL, Sidhu A, Carolan M, Triana E, Summers C, Joos E, Ball CG, Hameed SM. Extracorporeal life support in trauma: Indications and techniques. J Trauma Acute Care Surg 2024; 96:145-155. [PMID: 37822113 DOI: 10.1097/ta.0000000000004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Clarity about indications and techniques in extracorporeal life support (ECLS) in trauma is essential for timely and effective deployment, and to ensure good stewardship of an important resource. Extracorporeal life support deployments in a tertiary trauma center were reviewed to understand the indications, strategies, and tactics of ECLS in trauma. METHODS The provincial trauma registry was used to identify patients who received ECLS at a Level I trauma center and ECLS organization-accredited site between January 2014 and February 2021. Charts were reviewed for indications, technical factors, and outcomes following ECLS deployment. Based on this data, consensus around indications and techniques for ECLS in trauma was reached and refined by a multidisciplinary team discussion. RESULTS A total of 25 patients underwent ECLS as part of a comprehensive trauma resuscitation strategy. Eighteen patients underwent venovenous ECLS and seven received venoarterial ECLS. Nineteen patients survived the ECLS run, of which 15 survived to discharge. Four patients developed vascular injuries secondary to cannula insertion while four patients developed circuit clots. On multidisciplinary consensus, three broad indications for ECLS and their respective techniques were described: gas exchange for lung injury, extended damage control for severe injuries associated with the lethal triad, and circulatory support for cardiogenic shock or hypothermia. CONCLUSION The three broad indications for ECLS in trauma (gas exchange, extended damage control and circulatory support) require specific advanced planning and standardization of corresponding techniques (cannulation, circuit configuration, anticoagulation, and duration). When appropriately and effectively integrated into the trauma response, ECLS can extend the damage control paradigm to enable the management of complex multisystem injuries. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Alex Lee
- From the Division of General Surgery, Department of Surgery (A.L., G.T., S.A.-K., N.G., E.J., S.M.H.), Division of Critical Care, Department of Medicine (A.L., S.T., N.G., G.F., H.D.K., G.I., M.H.), Department of Anesthesiology and Perioperative Care (A.L., G.F., G.I., M.C.), University of British Columbia; Perfusion Services (K.T., A.S., E.T., C.S.), Vancouver General Hospital, Vancouver, BC; and Division of General Surgery, Department of Surgery (C.G.B.), University of Calgary, Calgary, AB, Canada
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10
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Endeshaw AS, Dejen ET, Zewdie BW, Addisu BT, Molla MT, Kumie FT. Perioperative mortality among trauma patients in Northwest Ethiopia: a prospective cohort study. Sci Rep 2023; 13:22859. [PMID: 38129464 PMCID: PMC10739862 DOI: 10.1038/s41598-023-50101-8] [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: 07/01/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Trauma is the leading cause of mortality in persons under 45 and a significant public health issue. Trauma is the most frequent cause of perioperative mortality among all surgical patients. Little is known about perioperative outcomes among trauma patients in low-income countries. This study aimed to assess the incidence and identify predictors of perioperative mortality among adult trauma victims at Tibebe Ghion Specialised Hospital. From June 1, 2019, to June 30, 2021, a prospective cohort study was conducted at Tibebe Ghion Specialized Hospital. Demographic, pre-hospital and perioperative clinical data were collected using an electronic data collection tool, Research Electronic Data Capture (REDCap). Cox proportional hazard model regression was used to assess the association between predictors and perioperative mortality among trauma victims. Crude and adjusted hazard ratio (HR) with a 95% confidence interval (CI) was computed; a p-value < 0.05 was a cutoff value to declare statistical significance. One thousand sixty-nine trauma patients were enrolled in this study. The overall incidence of perioperative mortality among trauma patients was 5.89%, with an incidence rate of 2.23 (95% CI 1.74 to 2.86) deaths per 1000 person-day observation. Age ≥ 65 years (AHR = 2.51, 95% CI: 1.04, 6.08), patients sustained blunt trauma (AHR = 3.28, 95% CI: 1.30, 8.29) and MVA (AHR = 2.96, 95% CI: 1.18, 7.43), trauma occurred at night time (AHR = 2.29, 95% CI: 1.15, 4.56), ASA physical status ≥ III (AHR = 3.84, 95% CI: 1.88, 7.82), and blood transfusion (AHR = 2.01, 95% CI: 1.08, 3.74) were identified as a significant predictor for perioperative mortality among trauma patients. In this trauma cohort, it was demonstrated that perioperative mortality is a healthcare burden. Risk factors for perioperative mortality among trauma patients were old age, patients sustaining blunt trauma and motor vehicle accidents, injuries at night, higher ASA physical status, and blood transfusion. Trauma care services need improvement in pre-hospital and perioperative care.
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Affiliation(s)
- Amanuel Sisay Endeshaw
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Eshetu Tesfaye Dejen
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bekalu Wubshet Zewdie
- Department of Orthopedics and Traumatology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Biniyam Teshome Addisu
- Department of Orthopedics and Traumatology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganew Terefe Molla
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fantahun Tarekegn Kumie
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Niyonsaba M, Nkeshimana M, Uwitonze JM, Davies J, Maine R, Nyinawankusi JD, Hunt M, Rickard R, Jayaraman S, Watt MH. Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda. Afr J Emerg Med 2023; 13:250-257. [PMID: 37767314 PMCID: PMC10520315 DOI: 10.1016/j.afjem.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants' perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.
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Affiliation(s)
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali), Rwanda
| | | | - Justine Davies
- University of Birmingham, Institute of Applied Health Research, United Kingdom
- Stellenbosch University, Centre for Global Surgery, Department of Global Health, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, South Africa
| | - Rebecca Maine
- University of Washington, Department of Surgery, United States
| | | | - McKenna Hunt
- University of Utah, Honors College, United States
| | - Rob Rickard
- Rwanda Build Program, Common World Inc., Rwanda
| | | | - Melissa H. Watt
- University of Utah, Department of Population Health Sciences, United States
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12
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Choi J, Vendrow EB, Moor M, Spain DA. Development and Validation of a Model to Quantify Injury Severity in Real Time. JAMA Netw Open 2023; 6:e2336196. [PMID: 37812422 PMCID: PMC10562944 DOI: 10.1001/jamanetworkopen.2023.36196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Importance Quantifying injury severity is integral to trauma care benchmarking, decision-making, and research, yet the most prevalent metric to quantify injury severity-Injury Severity Score (ISS)- is impractical to use in real time. Objective To develop and validate a practical model that uses a limited number of injury patterns to quantify injury severity in real time through 3 intuitive outcomes. Design, Setting, and Participants In this cohort study for prediction model development and validation, training, development, and internal validation cohorts comprised 223 545, 74 514, and 74 514 admission encounters, respectively, of adults (age ≥18 years) with a primary diagnosis of traumatic injury hospitalized more than 2 days (2017-2018 National Inpatient Sample). The external validation cohort comprised 3855 adults admitted to a level I trauma center who met criteria for the 2 highest of the institution's 3 trauma activation levels. Main Outcomes and Measures Three outcomes were hospital length of stay, probability of discharge disposition to a facility, and probability of inpatient mortality. The prediction performance metric for length of stay was mean absolute error. Prediction performance metrics for discharge disposition and inpatient mortality were average precision, precision, recall, specificity, F1 score, and area under the receiver operating characteristic curve (AUROC). Calibration was evaluated using calibration plots. Shapley addictive explanations analysis and bee swarm plots facilitated model explainability analysis. Results The Length of Stay, Disposition, Mortality (LDM) Injury Index (the model) comprised a multitask deep learning model trained, developed, and internally validated on a data set of 372 573 traumatic injury encounters (mean [SD] age = 68.7 [19.3] years, 56.6% female). The model used 176 potential injuries to output 3 interpretable outcomes: the predicted hospital length of stay, probability of discharge to a facility, and probability of inpatient mortality. For the external validation set, the ISS predicted length of stay with mean absolute error was 4.16 (95% CI, 4.13-4.20) days. Compared with the ISS, the model had comparable external validation set discrimination performance (facility discharge AUROC: 0.67 [95% CI, 0.67-0.68] vs 0.65 [95% CI, 0.65-0.66]; recall: 0.59 [95% CI, 0.58-0.61] vs 0.59 [95% CI, 0.58-0.60]; specificity: 0.66 [95% CI, 0.66-0.66] vs 0.62 [95%CI, 0.60-0.63]; mortality AUROC: 0.83 [95% CI, 0.81-0.84] vs 0.82 [95% CI, 0.82-0.82]; recall: 0.74 [95% CI, 0.72-0.77] vs 0.75 [95% CI, 0.75-0.76]; specificity: 0.81 [95% CI, 0.81-0.81] vs 0.76 [95% CI, 0.75-0.77]). The model had excellent calibration for predicting facility discharge disposition, but overestimated inpatient mortality. Explainability analysis found the inputs influencing model predictions matched intuition. Conclusions and Relevance In this cohort study using a limited number of injury patterns, the model quantified injury severity using 3 intuitive outcomes. Further study is required to evaluate the model at scale.
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Affiliation(s)
- Jeff Choi
- Department of Surgery, Stanford University, Stanford, California
| | - Edward B. Vendrow
- Department of Computer Science, Stanford University, Stanford, California
| | - Michael Moor
- Department of Computer Science, Stanford University, Stanford, California
| | - David A. Spain
- Department of Surgery, Stanford University, Stanford, California
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Shi M, Reddy S, Furmanchuk A, Holl JL, Hsia RY, Mackersie RC, Bilimoria KY, Stey AM. Re-triage moderates association between state trauma funding and lower mortality of trauma patients. Injury 2023; 54:110859. [PMID: 37311678 PMCID: PMC10529653 DOI: 10.1016/j.injury.2023.110859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Severely injured patients who are re-triaged (emergently transferred from an emergency department to a high-level trauma center) experience lower in-hospital mortality. Patients in states with trauma funding also experience lower in-hospital mortality. This study examines the interaction of re-triage, state trauma funding, and in-hospital mortality. STUDY DESIGN Severely injured patients (Injury Severity Score (ISS) >15) were identified from 2016 to 2017 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases in five states (FL, MA, MD, NY, WI). Data were merged with the American Hospital Association Annual Survey and state trauma funding data. Patients were linked across hospital encounters to determine if they were appropriately field triaged, field under-triaged, optimally re-triaged, or sub-optimally re-triaged. A hierarchical logistic regression modeling in-hospital mortality was used to quantify the effect of re-triage on the association between state trauma funding and in-hospital mortality, while adjusting for patient and hospital characteristics. RESULTS A total of 241,756 severely injured patients were identified. Median age was 52 years (IQR: 28, 73) and median ISS was 17 (IQR: 16, 25). Two states (MA, NY) allocated no funding, while three states (WI, FL, MD) allocated $0.09-$1.80 per capita. Patients in states with trauma funding were more broadly distributed across trauma center levels, with a higher proportion of patients brought to Level III, IV, or non-trauma centers, compared to patients in states without trauma funding (54.0% vs. 41.1%, p < 0.001). Patients in states with trauma funding were more often re-triaged, compared to patients in states without trauma funding (3.7% vs. 1.8%, p < 0.001). Patients who were optimally re-triaged in states with trauma funding experienced 0.67 lower adjusted odds of in-hospital mortality (95% CI: 0.50-0.89), compared to patients in states without trauma funding. We found that re-triage significantly moderated the association between state trauma funding and lower in-hospital mortality (p = 0.018). CONCLUSION Severely injured patients in states with trauma funding are more often re-triaged and experience lower odds of mortality. Re-triage of severely injured patients may potentiate the mortality benefit of increased state trauma funding.
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Affiliation(s)
- Meilynn Shi
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Susheel Reddy
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Al'ona Furmanchuk
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America; Center for Health Information Partnerships, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, United States of America
| | - Renee Y Hsia
- Department of Emergency Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, United States of America; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Robert C Mackersie
- Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Karl Y Bilimoria
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, United States of America
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
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Bérubé M, Côté C, Gagnon MA, Moore L, Tremblay L, Turgeon AF, Evans D, Berry G, Turcotte V, Belzile ÉL, Dale C, Orrantia E, Verret M, Dercksen J, Martel MO, Dupuis S, Chatillon CE, Lauzier F. Interdisciplinary strategies to prevent long-term and detrimental opioid use following trauma: a stakeholder consensus study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:933-940. [PMID: 36944264 PMCID: PMC10391591 DOI: 10.1093/pm/pnad037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations. DESIGN A consensus study using the nominal group technique. SETTING Four trauma systems in Canada. SUBJECTS Participants included expert clinicians and decision makers, and people with lived experience. METHODS Participants had to discuss the relevance and implementation of 15 strategies and then rank them using a 7-point Likert scale. Implementation considerations were identified through a synthesis of discussions. RESULTS A total of 41 expert stakeholders formed the nominal groups. Overall, eight strategies were favored: 1) using multimodal approach for pain management, 2) professional follow-up in physical health, 3) assessment of risk factors for opioid misuse, 4) physical stimulation, 5) downward adjustment of opioids based on patient recovery, 6) educational intervention for patients, 7) training offered to professionals on how to prescribe opioids, and 8) optimizing communication between professionals working in different settings. Discussions with expert stakeholders revealed the rationale for the selected strategies and identified issues to consider when implementing them. CONCLUSION This stakeholder consensus study identified, for further scientific study, a set of interdisciplinary strategies to promote appropriate opioid use following traumatic injuries. These strategies could ultimately decrease the burden associated with long-term opioid use.
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Affiliation(s)
- Mélanie Bérubé
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
| | - Caroline Côté
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
| | - Marc-Aurèle Gagnon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Social Preventive Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
| | - Lorraine Tremblay
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
| | - David Evans
- Department of Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Greg Berry
- Departement of Orthopaedic Surgery, McGill University Health Centre, Montréal, Quebec H3G 1A4, Canada
| | - Valérie Turcotte
- Department of Nursing, CIUSSS du Nord-de-l’île-de-Montréal, Montréal, Quebec H4J 1C5, Canada
| | - Étienne L Belzile
- Department of Surgery, Division of Orthopeadic Surgery, CHU de Québec-Université Laval, Québec City, Quebec GIV 1Z4, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario M5T 1P8, Canada
- University of Toronto Centre for the Study of Pain (UTCSP), Toronto, Ontario M5T 1P8, Canada
| | - Eli Orrantia
- Marathon Family Health Team, Marathon, Ontario P0T 2E0, Canada
| | - Michael Verret
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Judy Dercksen
- Quesnel Primary Care Clinic, Quesnel, British Columbia V2J 2K8, Canada
| | - Marc-Olivier Martel
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
- Faculty of Medicine & Dentistry, McGill University, Montréal, Quebec H3A 1G1, Canada
| | - Sébastien Dupuis
- Department of Pharmacy, CIUSSS du Nord-de-l’île-de-Montréal,Montréal, Quebec H4J 1C5, Canada
| | - Claude-Edouard Chatillon
- Division of Neurosurgery, CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Quebec G9A 5C5, Canada
| | - François Lauzier
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
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Haines KL, Truong T, Trujillo CN, Freeman JJ, Cox CE, Fernandez-More J, Morris R, Antonescu I, Burlotos A, Grisel B, Agarwal S, Kuchibhatla M. Factors Associated With Triage Decisions in Older Adult Trauma Patients: Impact on Mortality and Morbidity. J Surg Res 2023; 288:157-165. [PMID: 36989831 DOI: 10.1016/j.jss.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION As medical advances have significantly increased the life expectancy among older adults, the number of older patients requiring trauma care has risen proportionately. Nevertheless, it is unclear among this growing population which sociodemographic and economic factors are associated with decisions to triage and transfer to level I/II centers. This study aims to assess for any association between patient sociodemographic characteristics, triage decisions, and outcomes during acute trauma care presentations. METHODS The National Trauma Data Bank was queried for patients aged 65 and older with an injury severity score > 15 between the years 2007 to 2017. Factors associated with subsequent levels of triage on presentation were assessed using multivariate logistic regression, and associations of levels of triage with outcomes of mortality, morbidity, and hospital length of stay are examined using logistic and linear regression models. RESULTS Triage of 210,310 older adult trauma patients showed significant findings. American Indian patients had higher odds of being transferred to level I/II centers, while Asian, Black, and Native Hawaiian patients had lower odds of being transferred to level I/II centers when compared to Caucasian patients (P < 0.001). Regarding insurance, self-pay (uninsured) patients were less likely to be transferred to a higher level of care; however, this was also demonstrated in private insurance holders (P < 0.001). Caucasian patients had significantly higher odds of mortality, with Black patients (odds ratio [OR] 0.80 [0.75, 0.85]) and American Indian patients (OR 0.87 [0.72, 1.04]) having significantly lower odds (P < 0.001). Compared to government insurance, private insurance holders (OR 0.82 [0.80, 0.85]) also had significantly lower odds of mortality, while higher odds among self-pay were observed (OR 1.75 [1.62, 1.90]), (P < 0.001). CONCLUSIONS Access to insurance is associated with triage decisions involving older adults sustaining trauma, with lower access increasing mortality risk. Factors such as race and gender were less likely to be associated with triage decisions. However, due to this study's retrospective design, further prospective analysis is necessary to fully assess the decisions that influence trauma triage decisions in this patient population.
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16
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Culbert MH, Nelson A, Obaid O, Castanon L, Hosseinpour H, Anand T, El-Qawaqzeh K, Stewart C, Reina R, Joseph B. Failure-to-rescue and mortality after emergent pediatric trauma laparotomy: How are the children doing? J Pediatr Surg 2023; 58:537-544. [PMID: 36150930 DOI: 10.1016/j.jpedsurg.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Emergent trauma laparotomy is associated with mortality rates of up to 40%. There is a paucity of data on the outcomes of emergent trauma laparotomies performed in the pediatric population. The aim of our study was to describe the outcomes, including mortality and FTR, among pediatric trauma patients undergoing emergent laparotomy and identify factors associated with failure-to-rescue (FTR). METHODS We performed a one-year (2017) retrospective cohort analysis of the American College of Surgeons Trauma Quality Improvement Program dataset. All pediatric trauma patients (age <18 years) who underwent emergent laparotomy (laparotomy performed within 2 h of admission) were included. Outcome measures were major in-hospital complications, overall mortality, and failure-to-rescue (death after in-hospital major complication). Multivariate regression analysis was performed to identify factors independently associated with failure-to-rescue. RESULTS Among 120,553 pediatric trauma patients, 462 underwent emergent laparotomy. Mean age was 14±4 years, 76% of patients were male, 49% were White, and 50% had a penetrating mechanism of injury. Median ISS was 25 [13-36], Abdomen AIS was 3 [2-4], Chest AIS was 2 [1-3], and Head AIS was 2 [0-5]. The median time in ED was 33 [18-69] minutes, and median time to surgery was 49 [33-77] minutes. The most common operative procedures performed were splenectomy (26%), hepatorrhaphy (17%), enterectomy (14%), gastrorrhaphy (14%), and diaphragmatic repair (14%). Only 22% of patients were treated at an ACS Pediatric Level I trauma center. The most common major in-hospital complications were cardiac (9%), followed by infectious (7%) and respiratory (5%). Overall mortality was 21%, and mortality among those presenting with hypotension was 31%. Among those who developed in-hospital major complications, the failure-to-rescue rate was 31%. On multivariate analysis, age younger than 8 years, concomitant severe head injury, and receiving packed red blood cell transfusion within the first 24 h were independently associated with failure-to-rescue. CONCLUSIONS Our results show that emergent trauma laparotomies performed in the pediatric population are associated with high morbidity, mortality, and failure-to-rescue rates. Quality improvement programs may use our findings to improve patient outcomes, by increasing focus on avoiding hospital complications, and further refinement of resuscitation protocols. LEVEL OF EVIDENCE Level IV STUDY TYPE: Epidemiologic.
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Affiliation(s)
- Michael Hunter Culbert
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Adam Nelson
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Omar Obaid
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Tanya Anand
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Khaled El-Qawaqzeh
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Collin Stewart
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Raul Reina
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States.
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Colosimo C, Sirover L, Porter J, Fox N. The Bottom Line: Trauma Center Viability During COVID-19. J Surg Res 2023; 283:867-871. [PMID: 36915014 PMCID: PMC9684105 DOI: 10.1016/j.jss.2022.11.056] [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: 02/27/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The COVID-19 pandemic was a potential threat to the viability of trauma centers and health systems in general. We sought to answer the question of how COVID-19 was associated with patient characteristics as well as trauma center volume, finances, and viability. METHODS We reviewed 6375 patients admitted to our verified Level 1 trauma center during two time periods: pre-COVID (February 2019-February 2020) and COVID (March 2020-March 2021). Three thousand ninety-nine patients were admitted pre-COVID and 3276 were admitted during COVID. Data including case-mix index (CMI), total contribution margin, insurance status, age, race, gender, ethnicity, and injury mechanism were collected from the trauma registry and finance databases and analyzed. A P < 0.05 was considered significant. RESULTS Trauma admissions decreased initially during COVID but returned to and ultimately surpassed admission trends pre-COVID. Trauma revenue and patient acuity increased significantly along with a decrease in the number of underinsured patients during COVID. When evaluating all service lines, the trauma center was the highest contributor to overall hospital revenue. CONCLUSIONS Despite a decrease in admissions for other service lines and a pause in elective surgeries during the pandemic, the trauma center remained unaffected. In addition, trauma was the most significant contributor to the bottom line of the health system. These findings underscore the need to maintain and even increase trauma center resources and staffing to ensure that optimal care is provided to critically ill and injured patients.
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Affiliation(s)
| | - Lilly Sirover
- Cooper University Hospital, Trauma, Camden, New Jersey
| | - John Porter
- Cooper University Hospital, Trauma, Camden, New Jersey
| | - Nicole Fox
- Cooper University Hospital, Trauma, Camden, New Jersey
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18
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Shaw MR, Godzdanker I, Hawbaker N, McManis BG. Guiding Emergency Treatment With Extended Focused Assessment With Sonography in Trauma by Emergency Responders (GET eFASTER). Air Med J 2023; 42:42-47. [PMID: 36710034 DOI: 10.1016/j.amj.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/11/2022] [Accepted: 09/22/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Prehospital medicine has struggled to manage critical patients without the resources available to hospital-based teams. Point-of-care ultrasound could bridge this resource gap by providing critical insight into the pathology of trauma patients. This study aimed to determine if early positive extended focused assessment with sonography in trauma (eFAST) identification would lead to improved patient outcomes. METHODS This is a prospective observational trial that took place from February 1, 2019, to August 13, 2021. Paramedics, with no prior ultrasound experience, at a single ground ambulance agency were trained in obtaining and interpretating eFAST examinations. RESULTS Thirty-seven paramedics were trained and performed a total of 502 eFAST examinations with a total correct interpretation rate of 97.35%. There was a sensitivity of 30.0%/75.0%, specificity of 98.75%/94.05%, a positive predictive value of 33.33%/37.5%, a negative predictive value of 98.55%/98.75%, a positive likelihood ratio of 24.05/12.6, and a negative likelihood ratio of 0.71/0.27 for all exam/patient-only scans. The time spent on scene for eFAST and non-eFAST calls was not significantly different (F3, 2,512 = 2.59, P = .051, η2 = .003). CONCLUSION Although we were able to show successful training and interpretation of eFAST with paramedics, given the low prevalence of disease, our study did not show eFAST use improving patient outcome. However, the large likelihood ratio suggests its benefit may lie with appropriate trauma resource utilization.
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Affiliation(s)
| | | | | | - Beth G McManis
- School of Nursing, Northern Arizona University, Flagstaff, AZ
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Truchot J, Benhamed A, Batomen B, Boucher V, Malo C, Chauny JM, de Champlain F, Émond M. Trauma team leader and early mortality: An interrupted time series analysis. Am J Emerg Med 2022; 62:32-40. [DOI: 10.1016/j.ajem.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022] Open
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20
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Sakran JV, Lunardi N. Reducing Firearm Injury and Death in the United States. Adv Surg 2022; 56:49-67. [PMID: 36096577 DOI: 10.1016/j.yasu.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Firearms injury is a major cause of American morbidity and mortality. Although the firearm is a common vector, the intentions with which it is used represent a wide array of social ills-suicide, community violence, domestic violence, mass shootings, legal intervention, and unintended injury. The political and social underpinnings of this epidemic are inseparable from its prevention measures. Surgeons have an important role in firearm policy, research, prehospital and hospital advances, trauma survivor networks, and hospital-based violence prevention programs. It is only through interdisciplinary, multilevel, evidence-based prevention measures that the tides will turn on American firearm injury.
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Affiliation(s)
- Joseph V Sakran
- Emergency General Surgery, Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower / Suite 6107B, Baltimore, MD 21287, USA.
| | - Nicole Lunardi
- Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9159, USA
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21
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Ye J, Lin Y, Chen S. Application Value of Emergency Bedside Echocardiography in Early Warning of Acute and Severe Shock and Clinical Classification. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1634866. [PMID: 35903439 PMCID: PMC9325336 DOI: 10.1155/2022/1634866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
Objective A case-control study was conducted to explore the application value of emergency bedside echocardiography in early warning of acute and severe shock and clinical classification. Methods A total of 135 critically ill patients admitted to ICU from August 2019 to November 2020 were divided into shock group (n = 53) and nonshock group (n = 82) according to the occurrence of shock. The internal diameter index of inferior vena cava was measured and recorded by bedside ultrasound in patients with shock before and after treatment and in patients without shock. Shock index and inferior vena cava diameter deformation index (SCI) were calculated according to the results. The diagnostic time and curative effect of different ultrasonic examination methods for the types of shock were compared and analyzed. Results At admission, the maximum and minimum ventilation of inferior vena cava in patients without shock were higher than those in the shock group, and the internal diameter deformation index of inferior vena cava in the shock group was higher than that in the shock group (P < 0.05). In the shock group, IVCmax and IVCmin before and after treatment were higher than those before resuscitation, while SCI was lower than that before resuscitation. The results of ROC curve analysis showed that SCI and IVCmin were significantly better than IVCmax and IVCmin in predicting shock area and slightly better than IVCmin. There was significant difference in diagnosis time between the two groups (P < 0.05). The specificity, positive predictive value, and negative predictive value of emergency ultrasound diagnosis were lower than those of clinical diagnosis (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of emergency ultrasound diagnosis were lower than those of clinical diagnosis (P < 0.05). The sensitivity and positive predictive value of the emergency ultrasound group were higher than those of the routine ultrasound group (P < 0.05). The diagnosis rate of shock type AUC in the emergency ultrasound group was 0.854, and the diagnostic value was high. Conclusion IVCmax, IVCmin, and SCI obtained by bedside ultrasound have certain clinical significance for the diagnosis and treatment of shock. Emergency bedside ultrasound examination and measurement of shock patients are helpful to quickly evaluate and identify the types of early shock.
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Affiliation(s)
- Juan Ye
- Ultrasound Imaging Department, The First People's Hospital of Jiangxia, Wuhan City, Hubei Province 430200, China
| | - Yan Lin
- Ultrasound Imaging Department, The First People's Hospital of Jiangxia, Wuhan City, Hubei Province 430200, China
| | - Shaolin Chen
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020 Guangdong, China
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22
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Bonne S. Invited Commentary: The Trauma Center as a Beacon of Public Health. J Am Coll Surg 2022; 234:735-736. [PMID: 35426383 DOI: 10.1097/xcs.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Broecker JS, Ryan J, McCracken J, Langland-Orban B, Botty Van den Bruele A, Yorkgitis BK, Pracht E, Crandall M. Disparities in Demographics and Outcomes Based on Trauma Center Ownership. J Surg Res 2022; 273:132-137. [DOI: 10.1016/j.jss.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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24
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An Educational Outreach Program: A Trauma System's 5-Year Experience. J Trauma Nurs 2022; 29:152-157. [PMID: 35536344 DOI: 10.1097/jtn.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American College of Surgeons Committee on Trauma requires Level I and II trauma centers to provide educational outreach to lower-level facilities. Although outreach is a required part of any trauma system, very little is published on the resources required for a successful program. OBJECTIVE The purpose of this article is to provide a comprehensive roadmap of the required components to achieve a successful trauma outreach program. METHODS This project describes the development and implementation of an educational outreach program from January 2016 to December 2020 that has grown from 27 facilities within one western state to 49 facilities across 14 different states. Program components measured include the number and attendance of trauma courses offered, including the Trauma Nursing Core Course (TNCC), Advanced Trauma Life Support (ATLS), Rural Trauma Team Development Course (RTTDC), the number of trauma meetings and webinars provided, total trauma center designation and reviews, total states reached, and total trauma center collaborations. RESULTS From 2016 to 2020, the program more than doubled the number of TNCC and ATLS courses, maintained the number of RTTDC offered, and observed attendance rate increases of 33% and 11% for TNCC and ATLS courses, respectively. Outreach leadership attended 44 trauma meetings and educational webinars using virtual platform technology, nearly doubling the trauma center outreach with expansion across 14 states resulting in important changes in practice. CONCLUSION With administrative support, effective leadership, and technology, outreach programs can serve as important resources for statewide trauma systems.
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CENTER FOR TRAUMA SURVIVORSHIP IMPROVES POST-DISCHARGE FOLLOW-UP AND RETENTION. J Trauma Acute Care Surg 2022; 93:118-123. [PMID: 35393386 DOI: 10.1097/ta.0000000000003634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the need for high-level care persists post-discharge, severely injured trauma survivors have historically poor adherence to follow-up. We hypothesized that a dedicated Center for Trauma Survivorship (CTS) improves follow-up and facilitates post-discharge specialty care. METHODS Retrospective study of "CTS eligible" trauma patients before (Jan - Dec 2017) and after (Jan - Dec 2019) creation of the CTS. Patients with an ICU stay ≥2 days or a New Injury Severity Score ≥ 16 are CTS eligible. The before (PRE) cohort was followed through Dec 2018 and the after (CTS) cohort through Dec 2020. Primary outcome was follow-up within the hospital system exclusive of mental health and rehabilitative therapy appointments. Secondary outcomes include post-discharge surgical procedures and specialty-specific follow-up. RESULTS There were no significant differences in demographics or hospital duration in the PRE (n = 177) and CTS (n = 119) cohorts. Of the CTS group, 91% presented for outpatient follow-up within the hospital system, compared to 73% in the Pre group (p < 0.001). In the PRE cohort, only 39% were seen by the trauma service compared to 62% in the CTS cohort (p < 0.001). CTS patients also had increased follow-up with other providers (80% vs 65%; p = 0.006). Notably, 33% of CTS patients had additional surgery compared to only 20% in the PRE group (p = 0.011). CTS patients had over 20% more outpatient visits (1,280 vs 1,006 visits). CONCLUSION Despite the follow-up period for the CTS cohort occurring during the peak of the COVID-19 pandemic, limiting availability of outpatient services, our CTS significantly improved follow-up with trauma providers, as well as with other specialties. The CTS patients also underwent significantly more secondary operations. These data demonstrate that creation of a CTS can improve the post-discharge care of severely injured trauma survivors, allowing for care coordination within the healthcare system, retaining patients, generating revenue and providing needed follow-up care. LEVEL OF EVIDENCE Therapeutic, Level IV.
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26
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Brown HA, Tidwell C, Prest P. Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives. Afr J Emerg Med 2022; 12:53-60. [PMID: 35070655 PMCID: PMC8761604 DOI: 10.1016/j.afjem.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Trauma training for front-line providers is a critical component of injury mitigation and trauma systems strengthening. Although the Advanced Trauma Life Support (ATLS) course is standard in much of the world, cost and administrative barriers are prohibitive to deploying the course in many low and middle income countries (LMICs). The purpose of this study was to identify alternative trauma training courses used in LMICs by scoping review and compare their effectiveness. METHODS Several peer-reviewed and grey literature databases were searched for relevant articles describing trauma training courses for front-line medical providers in LMICs. Studies were included if: performed in a LMIC; utilized a general trauma training course other than ATLS; trainees were hospital-based medical providers; study included some type of outcome measure. RESULTS A total of 34 manuscripts met inclusion criteria. The majority of courses were novel, hospital-initiated courses and ranged in length from 1 day to 1 week. Physicians were the most common target audience, followed by medical students and nurses. Courses were taught in 24 different countries throughout the Middle East, Asia, Latin America and Africa. Comparison of pre- and post-test knowledge was the most common metric used and nearly all courses demonstrated a statistically significant knowledge gain. One study demonstrated a reduction in mortality for injured patients after course implementation. The majority of courses were a collaboration between universities in a high income country and local faculty/practitioners in the LMIC where the course was taught. Reported cost per participant ranged from $10 to $232 USD. CONCLUSIONS Several trauma courses are currently being utilized in LMICs effectively with increases in knowledge gained and at a lower reported cost than ATLS. More research is needed to link trauma training courses to patient outcomes.
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Affiliation(s)
- Heather A. Brown
- Prisma Health Midlands/University of South Carolina, Department of Emergency Medicine, Columbia, SC, USA
| | - Caitlin Tidwell
- Prisma Health Midlands/University of South Carolina, Department of Emergency Medicine, Columbia, SC, USA
| | - Phillip Prest
- Prisma Health Midlands/University of South Carolina, Department of Surgery, Columbia, SC, USA
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Global Survey of Demand-Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation. World J Surg 2022; 46:1059-1066. [DOI: 10.1007/s00268-022-06461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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28
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Neeki MM, Serrano J, Dong F, Chan MH, Fernandez D, Neeki AS, Vara R, Wong DT, Borger R, Tran L. Variation in Trauma Team Response Fees in United States Trauma Centers: An Additional Undisclosed Variable Cost in Trauma Care. Cureus 2022; 14:e21776. [PMID: 35251846 PMCID: PMC8890606 DOI: 10.7759/cureus.21776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/05/2022] Open
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Liu A, Nguyen J, Ehrlich H, Bisbee C, Santiesteban L, Santos R, McKenney M, Elkbuli A. Emergency Resuscitative Thoracotomy for Civilian Thoracic Trauma in the Field and Emergency Department Settings: A Systematic Review and Meta-Analysis. J Surg Res 2022; 273:44-55. [PMID: 35026444 DOI: 10.1016/j.jss.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Emergency department resuscitative thoracotomy (ED-RT) or prehospital resuscitative thoracotomy (PH-RT) is performed for trauma patients with impending or full cardiovascular collapse. This systematic review and meta-analysis analyze outcomes in patients with thoracic trauma receiving PH-RT and ED-RT. METHODS PubMed, JAMA Network, and CINAHL electronic databases were searched to identify studies published on ED-RT or PH-RT between 2000-2020. Patients were grouped by location of procedure and type of thoracic injury (blunt versus penetrating). RESULTS A total of 49 studies met the criteria for qualitative analysis, and 43 for quantitative analysis. 43 studies evaluated ED-RT and 5 evaluated PH-RT. Time from arrival on scene to PH-RT >5 min was associated with increased neurological complications and time from the initial encounter to PH-RT or ED-RT >10 min was associated with increased mortality. ISS ≥ 25 and absent signs of life were also associated with increased mortality. There was higher mortality in all PH-RT (93.5%) versus all ED-RT (81.8%) (P = 0.02). Among ED-RTs, a significant difference was found in mortality rate between patients with blunt (92.8%) versus penetrating (78.7%) injuries (P < 0.001). When considering only blunt or penetrating injury types, no significant difference in RT mortality rate was found between ED-RT and PH-RT (P = 0.65 and P = 0.95, respectively). CONCLUSIONS ED-RT and PH-RT are potentially life-saving procedures for patients with penetrating thoracic injuries in extremis and with signs of life. The efficacy of this procedure is time sensitive. Moreover, there appears to be a greater mortality risk for patients with thoracic trauma receiving RT in the PH setting compared to the ED setting. More studies are needed to determine the significance of PH-RT mortality.
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Affiliation(s)
- Amy Liu
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Jackie Nguyen
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Haley Ehrlich
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Charles Bisbee
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Luis Santiesteban
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Radleigh Santos
- Department of Mathematics, NOVA Southeastern University, Fort Lauderdale, Florida
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.
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30
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Siller RA, Skubic JJ, Almeda JL, Villarreal JF, Kaplan AE. Candida pericarditis presenting with cardiac tamponade and multiple organ failure after combined damage control thoracotomy and laparotomy with splenectomy in a trauma patient: Case report and review of literature. Trauma Case Rep 2021; 37:100564. [PMID: 34917734 PMCID: PMC8669452 DOI: 10.1016/j.tcr.2021.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and required antifungals and surgical reintervention with thoracotomy for drainage. A literature search of the reported cases demonstrates that Candida pericarditis is indeed a rare but fatal condition if not identified and treated appropriately. This article discusses the difficulties we encountered while recognizing the disorder in our patient and proposes a guideline to adequately treat the condition in an effective and timely manner. Candida pericarditis poses a special challenge for the physician since its correct diagnosis and management requires a multidisciplinary approach.
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Affiliation(s)
- R A Siller
- University of Texas at Rio Grande Valley - General Surgery Residency at Doctors Hospital at Renaissance, 5321 S, McColl Road, Edinburg, TX 78569, United States of America
| | - J J Skubic
- DHR Health Surgery Institute, Department of Trauma and Critical Care, 1100 E. Dove Ave, Suite 201, McAllen, TX 78504, United States of America
| | - J L Almeda
- DHR Health Transplant Institute, Hepatobiliary, Pancreas and Organ Transplantation Center, 5540 Raphael Drive, Edinburg, TX 78539, United States of America
| | - J F Villarreal
- DHR Health Heart Institute, 224 Lindberg Ave, McAllen, TX 78501, United States of America
| | - A E Kaplan
- Pulmonary Sleep Center of the Rio Grande Valley, 5300 N, McColl Rd, McAllen, TX 78504, United States of America
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Do SN, Luong CQ, Pham DT, Nguyen MH, Ton TT, Hoang QTA, Nguyen DT, Pham TTN, Hoang HT, Khuong DQ, Nguyen QH, Nguyen TA, Tran TT, Vu LD, Van Nguyen C, McNally BF, Ong MEH, Nguyen AD. Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study. BMC Emerg Med 2021; 21:148. [PMID: 34814830 PMCID: PMC8609736 DOI: 10.1186/s12873-021-00542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. METHODS We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. RESULTS Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). CONCLUSION In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.
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Affiliation(s)
- Son Ngoc Do
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam. .,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tra Thanh Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Quoc Trong Ai Hoang
- Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam
| | - Dat Tuan Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Thao Thi Ngoc Pham
- Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.,Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hanh Trong Hoang
- Intensive Care Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Hue City, Thua Thien Hue, Vietnam
| | - Dai Quoc Khuong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Quan Huu Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Long Duc Vu
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Bryan Francis McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
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Burzyńska M, Pikala M. Decreasing Trends in Road Traffic Mortality in Poland: A Twenty-Year Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910411. [PMID: 34639711 PMCID: PMC8508264 DOI: 10.3390/ijerph181910411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to assess mortality trends due to road traffic accidents in Poland between 1999 and 2018. The study material was a database including 7,582,319 death certificates of all inhabitants of Poland who died in the analyzed period (104,652 people died of transport accidents). Crude deaths rates (CDR), standardized death rates (SDR) and joinpoint models were used. Annual percentage change (APC) for each segment of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. CDR decreased from 19.7 per 100,000 population in 1999 to 9.6 per 100,000 population in 2018; APC was -4.1% (p < 0.05) while SDR decreased from 20.9 to 10.9 per 100,000; APC was -4.1% (p < 0.05). Large differences in traffic accident-related mortality were observed between men and women. An analysis by gender and age shows that the decline in the number of deaths due to traffic accidents has been slowed down in the oldest age group, 65+, in both males and females. There is a need for in-depth analyses aimed at introducing effective preventive solutions in the field of road traffic safety in Poland. Legal regulations should particularly refer to the most endangered groups of road users.
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