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Matthews L, Kelly E, Fleming A, Byerly S, Fischer P, Molyneaux I, Kerwin A, Howley I. An Analysis of Injured Patients Treated at Level 1 Trauma Centers Versus Other Centers: A Scoping Review. J Surg Res 2023; 284:70-93. [PMID: 36549038 DOI: 10.1016/j.jss.2022.11.062] [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: 06/03/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Trauma systems continue to evolve to create the best outcomes possible for patients who have undergone traumatic injury. OBJECTIVE This review aims to evaluate the existing research on outcomes based on field triage to a Level 1 trauma center (L1TC) compared to other levels of hospitals and nontrauma centers. METHODS A structured literature search was conducted using PubMed, CINAHL, Embase, and the Cochrane Database. Studies analyzing measures of morbidity, mortality, and cost after receiving care at L1TCs compared to lower-level trauma centers and nontrauma centers in the United States and Canada were included. Three independent reviewers reviewed abstracts, and two independent reviewers conducted full-text review and quality assessment of the included articles. RESULTS Twelve thousand five hundred fourteen unique articles were identified using the literature search. 61 relevant studies were included in this scoping review. 95.2% of included studies were national or regional studies, and 96.8% were registry-based studies. 72.6% of included studies adjusted their results to account for injury severity. The findings from receiving trauma care at L1TCs vary depending on severity of injury, type of injury sustained, and patient characteristics. Existing literature suffers from limitations inherent to large de-identified databases, making record linkage between hospitals impossible. CONCLUSIONS This scoping review shows that the survival benefit of L1TC care is largest for patients with the most severe injuries. This scoping review demonstrates that further research using high-quality data is needed to elucidate more about how to structure trauma systems to improve outcomes for patients with different severities of injuries and in different types of facilities.
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Affiliation(s)
- Lynley Matthews
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Emma Kelly
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew Fleming
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Saskya Byerly
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Peter Fischer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ian Molyneaux
- Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew Kerwin
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Isaac Howley
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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David SD, Aroke A, Roy N, Solomon H, Lundborg CS, Gerdin Wärnberg M. Measuring socioeconomic outcomes in trauma patients up to one year post-discharge: A systematic review and meta-analysis. Injury 2022; 53:272-285. [PMID: 34706829 DOI: 10.1016/j.injury.2021.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma accounts for nearly one-tenth of the global disability-adjusted life-years, a large proportion of which is seen in low- and middle-income countries (LMICs). Trauma can affect employment opportunities, reduce social participation, be influenced by social support, and significantly reduce the quality of life (QOL) among survivors. Research typically focuses on specific trauma sub-groups. This dispersed knowledge results in limited understanding of these outcomes in trauma patients as a whole across different populations and settings. We aimed to assess and provide a systematic overview of current knowledge about return-to-work (RTW), participation, social support, and QOL in trauma patients up to one year after discharge. METHODS We undertook a systematic review of the literature published since 2010 on RTW, participation, social support, and QOL in adult trauma populations, up to one year from discharge, utilizing the most commonly used measurement tools from three databases: MEDLINE, EMBASE, and the Cochrane Library. We performed a meta-analysis based on the type of outcome, tool for measurement, and the specific effect measure as well as assessed the methodological quality of the included studies. RESULTS A total of 43 articles were included. More than one-third (36%) of patients had not returned to work even a year after discharge. Those who did return to work took more than 3 months to do so. Trauma patients reported receiving moderate social support. There were no studies reporting social participation among trauma patients using the inclusion criteria. The QOL scores of the trauma patients did not reach the population norms or pre-injury levels even a year after discharge. Older adults and females tended to have poorer outcomes. Elderly individuals and females were under-represented in the studies. More than three-quarters of the included studies were from high-income countries (HICs) and had higher methodological quality. CONCLUSION RTW and QOL are affected by trauma even a year after discharge and the social support received was moderate, especially among elderly and female patients. Future studies should move towards building more high-quality evidence from LMICs on long-term socioeconomic outcomes including social support, participation and unpaid work.
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Affiliation(s)
- Siddarth Daniels David
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Doctors For You, Mumbai, India.
| | - Anna Aroke
- Doctors For You, Mumbai, India; WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | - Nobhojit Roy
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, USA
| | - Cecilia Stålsby Lundborg
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Gerdin Wärnberg
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Function, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
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Gross T, Morell S, Amsler F. Medically graded reduced capacity to work (RCW) following significant injury as explained by patient related outcome measures (PROMs) - A prospective trauma center evaluation. Disabil Health J 2021; 14:101114. [PMID: 34059469 DOI: 10.1016/j.dhjo.2021.101114] [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: 05/12/2020] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data is limited how well patient-reported longer-term outcome measures (PROMs) explain medically graded reduced capacity for work (RCW). OBJECTIVE This prospective study investigates the association of RCW with several PROMs in addition to demographic and injury-related variables in significantly injured of working age. METHODS Patients (New Injury Severity Score, NISS ≥ 8) were recruited consecutively. RCW, as registered by the largest Swiss accident insurer, was tested against demographic, trauma and treatment characteristics, and patients' contemporaneous two year rating of functional outcome and quality of life following trauma with measures such as the Short-Form (SF)-36 or Trauma Outcome Profile (TOP), using uni- and multivariable analysis. RESULTS 140 patients (mean 42 years, 2-year RCW rate 21%) participated in the longer-term follow-up of self-rated outcome. In multivariable analysis, all investigated baseline factors together accounted for 48% of the variance explaining 2-year postinjury RCW with 31% contributed by demographic, injury or treatment related variables, and 17% by patients' condition at hospital discharge. Patients' self-rated longer-term outcome provided 61% of the information on concurrent RCW, whereby 53% identified worsening of physical function (SF-36) and additional 8% constraints in daily activities (TOP). Four variables (Glasgow Outcome Scale at the time of hospital discharge and SF-36 physical functioning, TOP daily activities, SF-36 role physical at two years) explained 71% of RCW, corresponding to an area under the curve (AUC) of 0.95. CONCLUSIONS Objectively graded RCW 2 years after injury was found to be well explained by the combined information of patients' subjective longer-term outcome together with basic patient, trauma and treatment characteristics.
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Affiliation(s)
- Thomas Gross
- Department of Traumatology, Cantonal Hospital, Tellstr.1, CH-5001, Aarau, Switzerland.
| | - Sabrina Morell
- Department of Traumatology, Cantonal Hospital, Tellstr.1, CH-5001, Aarau, Switzerland
| | - Felix Amsler
- Amsler Consulting, Gundeldingerrain 111, CH-4059, Basel, Switzerland
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Jung YH, Wi DH, Shin SD, Tanaka H, Shaun GE, Chiang WC, Sun JT, Hsu LM, Kajino K, Jamaluddin SF, Kimura A, Holmes JF, Song KJ, Ro YS, Hong KJ, Moon SW, Park JO, Kim MJ. Comparison of trauma systems in Asian countries: a cross-sectional study. Clin Exp Emerg Med 2019; 6:321-329. [PMID: 31910503 PMCID: PMC6952627 DOI: 10.15441/ceem.18.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/11/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS). METHODS Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics. RESULTS Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%). CONCLUSION Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.
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Affiliation(s)
- Young Hee Jung
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Dae Han Wi
- Department of Emergency Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hideharu Tanaka
- Department of Emergency Medical System, Graduate School of Kokushikan University, Tokyo, Japan
| | - Goh E Shaun
- Acute and Emergency Care Center, Khoo Teck Paut Hospital, Singapore
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Li-Min Hsu
- Department of Traumatology and Critical Care, National Taiwan University Hospital, Taipei, Taiwan
| | - Kentaro Kajino
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - James F Holmes
- Department of Emergency Medicine, UC Davis Medical Center (JFH), Sacramento, CA, USA
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Woo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Hospital, Hallym University College of Medicine, Dongtan, Korea
| | - Min Jung Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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A reassessment of the impact of trauma systems consultation on regional trauma system development. J Trauma Acute Care Surg 2015; 78:1102-10. [DOI: 10.1097/ta.0000000000000653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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