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Venter M, Stassen W. A national retrospective descriptive analysis of critical care transfers in the private sector in South Africa. S Afr Med J 2023; 113:38-43. [PMID: 37882134 DOI: 10.7196/samj.2023.v113i8.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Critical care transfers (CCTs) are necessitated by the growing prevalence of high-acuity patients who require upgrade of care to multidisciplinary teams from less-equipped referring facilities. Owing to the high acuity of the critical care patient, specialised teams with advanced training and equipment are called upon to undertake these transfers. The inherent understanding of the potential effects, and therefore the needs of the critical care patient during transfer, are affected owing to the paucity of international, but more specifically, local data relating to CCTs. OBJECTIVES To describe a cohort of patients who underwent CCT by dedicated critical care retrieval services (CCRS) in the private sector in South Africa (SA). METHODS This retrospective, descriptive study sampled all paediatric and adult CCTs completed over a 1-year period (1 January 2017 - 31 December 2017) from the dedicated CCRS of two national emergency medical services in SA. All neonatal patients were excluded. Data were extracted from patient report forms by trained data extractors and subjected to descriptive analysis. RESULTS A total of 1 839 patients were transferred between the two services. A total of 3 143 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent primary diagnosis was cardiovascular disease (n=457, 25%), followed by infection (n=180, 10%) and head injury (n=133, 7%). Patients had an average of ~3 attachments, with the most prevalent being patient monitoring (n=2 856, 155%), peripheral intravenous access (n=794, 43%) and mechanical ventilation (n=445, 24%). A total of 2 152 instances of medication infusion or administration were required during transport, yielding an average of ~1 medication or infusion per patient transported. The most common medications recorded were central nervous system depressants (n=588, 32%), followed by analgesics (n=482, 26%) and inotropic or vasoactive agents (n=320, 17%). CONCLUSION This study provides insight into the demographics, most prevalent diagnoses and interfacility transfer monitoring needs of patients being transported in SA by two private dedicated CCRS. The results of this study may be used to inform future specialised critical care transport courses and qualifications, equipment procurement and scopes of practice for providers undertaking critical care transfers.
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Affiliation(s)
- M Venter
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - W Stassen
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Zhou Q, Huang H, Zheng L, Chen H, Zeng Y. Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study. BMC Emerg Med 2023; 23:5. [PMID: 36653746 PMCID: PMC9850752 DOI: 10.1186/s12873-023-00776-z] [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: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Little evidence suggests that trauma centres are associated with a lower risk of mortality in severely injured patients (Injury Severity Score (ISS) ≥16) with multiple injuries in China. The objective of this study was to determine the association between the establishment of trauma centres and mortality among severely injured patients with multiple injuries and to identify some risk factors associated with mortality. METHODS A retrospective single-centre study was performed including trauma patients admitted to the First Affiliated Hospital of Nanchang University (FAHNU) between January 2016 and December 2021. To determine whether the establishment of a trauma centre was an independent predictor of mortality, logistic regression analysis and propensity score matching (PSM) were performed. RESULTS Among 431 trauma patients, 172 were enrolled before the trauma centre was built, while 259 were included after the trauma centre was built. A higher frequency of older age and traffic accident injury was found in patients diagnosed after the trauma centre was built. The times for the completion of CT examinations, emergency operations and blood transfusions in the "after trauma centre" group were shorter than those in the "before trauma centre" group. However, the total expenditure of patients was increased. In the overall group, univariate and multivariate logistic regression analyses showed that a higher ISS was an independent predictor for worse mortality (OR = 17.859, 95% CI, 8.207-38.86, P < 0.001), while the establishment of a trauma centre was favourable for patient survival (OR = 0.492), which was also demonstrated by PSM. After determining the cut-off value of time for the completion of CT examination, emergency operation and blood transfusion, we found that the values were within the "golden one hour", and it was better for patients when the time was less than the cut-off value. CONCLUSION Our study showed that for severely injured patients, the establishment of a trauma centre was favourable for a lower mortality rate. Furthermore, the completion of a CT examination, emergency surgery and blood transfusion in a timely manner and a lower ISS were associated with a decreased mortality rate.
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Affiliation(s)
- Qiangping Zhou
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Haijin Huang
- grid.412604.50000 0004 1758 4073Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linhui Zheng
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Haiming Chen
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Yuanlin Zeng
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
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French WJ, Gunderson M, Travis D, Bieniarz M, Zegre‐Hemsey J, Goyal A, Jacobs AK. Emergency Interhospital Transfer of Patients With ST‐Segment–Elevation Myocardial Infarction: Call 9‐1‐1—The American Heart Association Mission: Lifeline Program. J Am Heart Assoc 2022; 11:e026700. [DOI: 10.1161/jaha.122.026700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT: The American Heart Association Mission: Lifeline program objectives are to improve the quality of care and outcomes for patients with ST‐segment–elevation myocardial infarction. Every minute of delay in treatment adversely affects 1‐year mortality. Transfer of patients safely and timely to hospitals with primary percutaneous coronary intervention capability is needed to improve outcomes. But treatment times continue to show delays, especially during interhospital transfers. A simple 3‐step process of an interhospital “Call 9‐1‐1” protocol may expedite this process. This STAT TRANSFER process uses a systems approach that considers diverse ways in which patients access care, how EMS responds and determines destinations, how referring hospital transfers are performed, urban and rural differences, and how receiving hospitals prepare for an incoming patient with ST‐segment–elevation myocardial infarction. This initiative suggests a strategy to reduce variability in interhospital transfer times using a STAT TRANSFER and a Call 9‐1‐1 process in a system of care that involves all stakeholders.
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Affiliation(s)
- William J. French
- Geffen School of Medicine at UCLA, Cardiac Catheterization Laboratory, Harbor‐UCLA Medical Center Torrance CA
| | - Mic Gunderson
- Center for Systems Improvement, Cambridge Consulting Group; Emergency Health Services University of Maryland Baltimore County MD
| | - David Travis
- EMS Programs Hillsborough Community College Tampa FL
| | - Mark Bieniarz
- New Mexico Heart Institute Lovelace Medical Center Albuquerque NM
| | - Jessica Zegre‐Hemsey
- School of Nursing; Department of Emergency Medicine The University of North Carolina at Chapel Hill NC
| | - Abhinav Goyal
- Emory Heart and Vascular Center, Emory Healthcare; Medicine (Cardiology) Emory School of Medicine; Emory Rollins School of Public Health Atlanta GA
| | - Alice K. Jacobs
- Department of Medicine Boston University School of Medicine and Boston Medical Center Boston MA
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Chiang YT, Lin TH, Hu RH, Lee PC, Shih HC. Predicting factors for major trauma patient mortality analyzed from trauma registry system. Asian J Surg 2020; 44:262-268. [PMID: 32859471 DOI: 10.1016/j.asjsur.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We investigated the predictors of mortality in major trauma patients using a trauma registry system database. METHODS Data were obtained from the trauma registry of a level I trauma center for all patients aged ≥18 years admitted to an intensive care unit (ICU) between January 1, 2006 and December 31, 2013. Models were adjusted for patient demographics, injury mechanism, preexisting comorbidity, Glasgow coma scale (GCS), injury severity score (ISS), emergency department (ED) and ICU procedures, surgical procedures, and complications. Multivariate logistic regression analysis was used to determine predictors of mortality and odds ratios of its associated factors. RESULTS In total, 1561 patients met the inclusion criteria. The overall mortality rate was 13.4%. After controlling for all variables in a logistic regression model, the factors associated with increased mortality risk (P < 0.05) were age ≥ 45 years; ISS > 24; GCS score < 8 and 8-12; fall accident; preexisting comorbidity of renal insufficiency; ED cardiopulmonary resuscitation (CPR) procedures; ICU blood transfusion; and cardiovascular, respiratory, digestive system and infection complications. CONCLUSION Our data showed some predictors of patient mortality after major trauma, most of which were determined during the trauma event. Only those treatment complications may be improved when performing the treatment procedures.
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Affiliation(s)
- Yueh-Tzu Chiang
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC; Department of Orthopedics, KuangTien General Hospital, Taiwan, ROC.
| | - Tzu-Hsin Lin
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC.
| | - Rey-Heng Hu
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Po-Chu Lee
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Hsin-Chin Shih
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC
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Moore L, Champion H, O’Reilly G, Leppaniemi A, Cameron P, Palmer C, Abu-Zidan FM, Gabbe B, Gaarder C, Yanchar N, Stelfox HT, Coimbra R, Kortbeek J, Noonan V, Gunning A, Leenan L, Gordon M, Khajanchi M, Shemilt M, Porgo V, Turgeon AF. Impact of trauma system structure on injury outcomes: a systematic review protocol. Syst Rev 2017; 6:12. [PMID: 28109306 PMCID: PMC5251247 DOI: 10.1186/s13643-017-0408-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/06/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of trauma care varies significantly across trauma systems and we know little about which components of trauma systems contribute to their effectiveness. The objective of the study described in this protocol is to systematically review evidence of the impact of trauma system components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization. METHODS We will perform a systematic review of studies evaluating the association between at least one trauma system component (e.g. accreditation by a central agency, interfacility transfer agreements) and at least one injury outcome (e.g. mortality, disability, resource use). We will search MEDLINE, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, thesis holdings, key injury organisation websites and conference proceedings for eligible studies. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles. Methodological quality will be evaluated using elements of the ROBINS-I tool and the Cochrane risk of bias tool for non-randomized and randomized studies, respectively. Strength of evidence will be evaluated using the GRADE tool. DISCUSSION We expect to advance knowledge on the components of trauma systems that contribute to their effectiveness. This may lead to recommendations on trauma system structure that will help policy-makers make informed decisions as to where resources should be focused. The review may also lead to specific recommendations for future research efforts. SYSTEMATIC REVIEW REGISTRATION This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 28-06-2016. PROSPERO 2016:CRD42016041336 Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016041336 .
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie–Urgence-Soins intensifs (Trauma–Emergency–Critical Care Medicine), CHU de Québec–Université Laval Research Center (Enfant-Jésus Hospital), 1401, 18e rue, local H-012a, Québec, G1J 1Z4 Canada
| | | | - Gerard O’Reilly
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ari Leppaniemi
- Department of Surgery, Helsinki University, Helsinki, Finland
| | - Peter Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Cameron Palmer
- Trauma Service, Royal Children’s Hospital, Melbourne, Australia
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California, San Diego Health System, San Diego, California USA
| | - John Kortbeek
- Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta Canada
| | - Vanessa Noonan
- Rick Hansen Institute, Vancouver, BC Canada
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amy Gunning
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke Leenan
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Malcolm Gordon
- Department of Emergency Medicine, University of Glasgow, Glasgow, UK
| | | | - Michèle Shemilt
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie–Urgence-Soins intensifs (Trauma–Emergency–Critical Care Medicine), CHU de Québec–Université Laval Research Center (Enfant-Jésus Hospital), 1401, 18e rue, local H-012a, Québec, G1J 1Z4 Canada
| | - Valérie Porgo
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
| | - Alexis F. Turgeon
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
| | - on behalf of the International Injury Care Improvement Initiative
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie–Urgence-Soins intensifs (Trauma–Emergency–Critical Care Medicine), CHU de Québec–Université Laval Research Center (Enfant-Jésus Hospital), 1401, 18e rue, local H-012a, Québec, G1J 1Z4 Canada
- U Health Sciences, Baltimore, Maryland USA
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Surgery, Helsinki University, Helsinki, Finland
- Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia
- Trauma Service, Royal Children’s Hospital, Melbourne, Australia
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California, San Diego Health System, San Diego, California USA
- Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta Canada
- Rick Hansen Institute, Vancouver, BC Canada
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Emergency Medicine, University of Glasgow, Glasgow, UK
- Seth G.S. Medical College and KEM Hospital, Mumbai, India
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Dinh MM, Russell SB, Bein KJ, Vallmuur K, Muscatello D, Chalkley D, Ivers R. Age-related trends in injury and injury severity presenting to emergency departments in New South Wales Australia: Implications for major injury surveillance and trauma systems. Injury 2017; 48:171-176. [PMID: 27542554 DOI: 10.1016/j.injury.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe population based trends and clinical characteristics of injury related presentations to Emergency Departments (EDs). DESIGN AND SETTING A retrospective, descriptive analysis of de-identified linked ED data across New South Wales, Australia over five calendar years, from 2010 to 2014. PARTICIPANTS Patients were included in this analysis if they presented to an Emergency Department and had an injury related diagnosis. Injury severity was categorised into critical (triage category 1-2 and admitted to ICU or operating theatre, or died in ED), serious (admitted as an in-patient, excluding above critical injuries) and minor injuries (discharged from ED). MAIN OUTCOME MEASURES The outcomes of interest were rates of injury related presentations to EDs by age groups and injury severity. RESULTS A total of 2.09 million injury related ED presentations were analysed. Minor injuries comprised 85.0%, and 14.1% and 1.0% were serious and critical injuries respectively. There was a 15.8% per annum increase in the rate of critical injuries per 1000 population in those 80 years and over, with the most common diagnosis being head injuries. Around 40% of those with critical injuries presented directly to a major trauma centre. CONCLUSION Critical injuries in the elderly have risen dramatically in recent years. A minority of critical injuries present directly to major trauma centres. Trauma service provision models need revision to ensure appropriate patient care. Injury surveillance is needed to understand the external causes of injury presenting to hospital.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, Australia; Discipline of Emergency Medicine, The University of Sydney, Australia.
| | | | | | | | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Australia
| | | | - Rebecca Ivers
- The George Institute for Global Health, The University of Sydney, Australia; School of Nursing and Midwifery, Flinders University, Australia
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