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Gauss T, de Jongh M, Maegele M, Cole E, Bouzat P. Trauma systems in high socioeconomic index countries in 2050. Crit Care 2024; 28:84. [PMID: 38493142 PMCID: PMC10943799 DOI: 10.1186/s13054-024-04863-w] [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: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.
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Affiliation(s)
- Tobias Gauss
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France.
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France.
| | - Mariska de Jongh
- Network Emergency Care Brabant (NAZB), ETZ Hospital, Tilburg, The Netherlands
| | - Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University Witten-Herdecke, Cologne, Germany
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Pierre Bouzat
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France
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2
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Tazarourte K, Harris T. Cognitive support: An effective way to enhance the Trauma Brain Injury guidelines implementation? Anaesth Crit Care Pain Med 2022; 41:101076. [PMID: 35472589 DOI: 10.1016/j.accpm.2022.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Karim Tazarourte
- SAMU 69/Urgences Hôpital Edouard Herriot, Hospices civils de Lyon, Lyon Cedex, France; Universite LYON 1 RESHAPE U 1290 Lyon 69003, France.
| | - Tim Harris
- Department of Emergency Medicine, Queen Mary University, London, United Kingdom; Department of Academic Affairs, Hamad Medical Corporation, Qatar
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3
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Pressat-Laffouilhère T, Balayé P, Dahamna B, Lelong R, Billey K, Darmoni SJ, Grosjean J. Evaluation of Doc'EDS: a French semantic search tool to query health documents from a clinical data warehouse. BMC Med Inform Decis Mak 2022; 22:34. [PMID: 35135538 PMCID: PMC8822768 DOI: 10.1186/s12911-022-01762-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unstructured data from electronic health records represent a wealth of information. Doc'EDS is a pre-screening tool based on textual and semantic analysis. The Doc'EDS system provides a graphic user interface to search documents in French. The aim of this study was to present the Doc'EDS tool and to provide a formal evaluation of its semantic features. METHODS Doc'EDS is a search tool built on top of the clinical data warehouse developed at Rouen University Hospital. This tool is a multilevel search engine combining structured and unstructured data. It also provides basic analytical features and semantic utilities. A formal evaluation was conducted to measure the impact of Natural Language Processing algorithms. RESULTS Approximately 18.1 million narrative documents are stored in Doc'EDS. The formal evaluation was conducted in 5000 clinical concepts that were manually collected. The F-measures of negative concepts and hypothetical concepts were respectively 0.89 and 0.57. CONCLUSION In this formal evaluation, we have shown that Doc'EDS is able to deal with language subtleties to enhance an advanced full text search in French health documents. The Doc'EDS tool is currently used on a daily basis to help researchers to identify patient cohorts thanks to unstructured data.
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Affiliation(s)
- Thibaut Pressat-Laffouilhère
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LITIS EA4108, Rouen University, Normandy, France
| | - Pierre Balayé
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France
| | - Badisse Dahamna
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France
| | - Romain Lelong
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France
| | - Kévin Billey
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LITIS EA4108, Rouen University, Normandy, France
| | - Stéfan J Darmoni
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France
| | - Julien Grosjean
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France. .,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France.
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Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5754114. [PMID: 34777535 PMCID: PMC8580668 DOI: 10.1155/2021/5754114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.
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Labarthe A, Mennecart T, Imfeld C, Lély P, Ausset S. Pre-hospital transfusion of post-traumatic hemorrhage: Medical and regulatory aspects. Transfus Clin Biol 2021; 28:391-396. [PMID: 34464713 DOI: 10.1016/j.tracli.2021.08.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
Data of good methodological quality have recently become available to support prehospital use of transfusion in the severe trauma setting. Consistent with recent guidelines for the implementation of damage control resuscitation in the hospital in this setting and in the wake of numerous cohort study data from wartime medicine, they are now guided by recent guidelines for the use of freeze-dried plasma. The main difficulties to overcome in order to implement a practice are of a regulatory and logistic nature.
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Affiliation(s)
- A Labarthe
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - T Mennecart
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - C Imfeld
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - P Lély
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France
| | - S Ausset
- French Military medical school, 331, avenue du Général-de-Gaulle, Bron, France.
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Abback PS, Brouns K, Moyer JD, Holleville M, Hego C, Jeantrelle C, Bout H, Rennuit I, Foucrier A, Codorniu A, Jurcisin I, Paugam-Burtz C, Gauss T. ISS is not an appropriate tool to estimate overtriage. Eur J Trauma Emerg Surg 2021; 48:1061-1068. [PMID: 33725158 DOI: 10.1007/s00068-021-01637-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this work is to study a cohort of patients of ISS < 15 admitted to a TC, and to determine the number of patients that ultimately benefited from the skills and resources specific of a level 1 trauma center. METHODS Retrospective study from a prospective cohort of patients admitted to TC (Beaujon Hospital, APHP) for suspected severe trauma from January 2011 to December 2017. The main outcome criterion was the use of surgery or interventional radiology within the first 24 h after admission of patients with ISS < 15. The secondary outcomes were stratified into severe (mortality, resuscitation care, length of stay in intensive care units) and non-severe criteria (mild head injury, hospital discharge or transfer within 24 h). RESULTS Of 3035 patients admitted during the study period, 1409 with an ISS < 15 were included, corresponding to a theoretical overtriage rate of 46.4%. Among these, 611 patients (43.4%) underwent emergency intervention within the first 24 h (586 surgical interventions, 19 direct transfers to the operating theater and 6 acts of interventional radiology), 238 (16.9%) of patients presented with severe and 531 (38%) with non-severe outcome criteria. CONCLUSION This work demonstrates that in a cohort of patients classified as ISS < 15 admitted to a TC, a considerable amount of TC-specific resources are required, and patients present with severe outcome criteria despite being classified as overtriaged. These results suggest that triage of trauma patients should be based on resource use and clinical outcome rather than anatomic criteria.
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Affiliation(s)
- Paër-Sélim Abback
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France.
| | - Kelly Brouns
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, APHP, Paris, France
| | - Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Mathilde Holleville
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Camille Hego
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Hélène Bout
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Isabelle Rennuit
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Arnaud Foucrier
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Anaïs Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Igor Jurcisin
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Catherine Paugam-Burtz
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France.,Université de Paris, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
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Thillard EM, Gautier S, Babykina E, Carton L, Amad A, Bouzillé G, Beuscart JB, Ficheur G, Chazard E. Psychiatric Adverse Events Associated With Infliximab: A Cohort Study From the French Nationwide Discharge Abstract Database. Front Pharmacol 2020; 11:513. [PMID: 32390850 PMCID: PMC7188945 DOI: 10.3389/fphar.2020.00513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/01/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction Infliximab (IFX) was the first anti-tumor necrosis factor (TNFα) antibody to be used in the treatment of severe chronic inflammatory diseases, such as Crohn’s disease and rheumatoid arthritis. A number of serious adverse drug reactions are known to be associated with IFX use; they include infections, malignancies, and injection site reactions. Although a few case reports have described potential psychiatric adverse events (including suicide attempts and manic episodes), the latter are barely mentioned in IFX’s summary of product characteristics. The objective of the present retrospective study was to detect potential psychiatric adverse events associated with IFX treatment by analyzing a national discharge abstract database. Materials and Methods We performed an historical cohort study by analyzing data from the French national hospital discharge abstract database (PMSI) between 2008 and 2014. All patients admitted with one of the five diseases treated with IFX were included. Results Of the 325,319 patients included in the study, 7,600 had been treated with IFX. The proportion of hospital admissions for one or more psychiatric events was higher among IFX-exposed patients (750 out of 7,600; 9.87%) than among non-exposed patients (17,456 out of 317,719; 5.49%). After taking account of potential confounders in the cohort as a whole, a semi-parametric Cox regression analysis gave an overall hazard ratio (HR) [95% confidence interval] (CI) of 4.5 [3.95; 5.13] for a hospital admission with a psychiatric adverse event during treatment with IFX. The HR (95%CI) for a depressive disorder was 4.97 (7.35; 6.68). Even higher risks were observed for certain pairs of adverse events and underlying pathologies: psychotic disorders in patients treated for ulcerative colitis (HR = 5.43 [2.01; 14.6]), manic episodes in patients treated for severe psoriasis (HR = 12.6 [4.65; 34.2]), and suicide attempts in patients treated for rheumatoid arthritis (HR = 4.45 [1.11; 17.9]). Discussion The present retrospective, observational study confirmed that IFX treatment is associated with an elevated risk of psychiatric adverse events. Depending on the disease treated, physicians should be aware of these potential adverse events.
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Affiliation(s)
- Eve-Marie Thillard
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Sophie Gautier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172, Center for Pharmacovigilance, Lille, France
| | - Evgeniya Babykina
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Louise Carton
- Univ. Lille, Inserm, CHU Lille, UMR_S1172, Medical Pharmacology Department, Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Guillaume Bouzillé
- University of Rennes, Inserm, CHU Rennes, UMR 1099 - LTSI, Rennes, France
| | | | - Grégoire Ficheur
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Emmanuel Chazard
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
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Epidemiology of trauma: From medico-administrative database to large prospective registry. Anaesth Crit Care Pain Med 2019; 38:439-440. [DOI: 10.1016/j.accpm.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bège T, Pauly V, Orleans V, Boyer L, Leone M. Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database. Anaesth Crit Care Pain Med 2019; 38:461-468. [DOI: 10.1016/j.accpm.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/18/2019] [Accepted: 02/02/2019] [Indexed: 12/01/2022]
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