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Wycech Knight J, Fokin AA, Menzione N, Rabinowitz SR, Viitaniemi SA, Puente I. Are geriatric transfer patients with traumatic brain injury at risk for worse outcomes compared to non-geriatric? Propensity-matched study. Brain Inj 2024; 38:659-667. [PMID: 38568043 DOI: 10.1080/02699052.2024.2337904] [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: 03/29/2023] [Accepted: 03/28/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy. METHODS A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without. RESULTS Patients with TBI constituted 54.4% of trauma transfers. Mean transfer time was 3.9 h. Propensity matched by Injury Severity Score and Abbreviated Injury Score (AIS) head geriatric compared to non-geriatric patients had more AC/AP use (53.9% vs 8.8%), repeat head computed tomography (93.7% vs 86.1%), intensive care unit (ICU) admissions (57.4% vs 45.7%) and mortality (9.8% vs 3.2%), all p < 0.004. Patients on AC/AP versus without had more ICU admissions (69.1% vs 51.8%, p < 0.001). Patients with AC/AP reversals compared to without reversals had more AIS head 5 (32.0% vs 13.1%), brain surgeries (17.8% vs 3.5%) and ICU admissions (84.8% vs 57.1%), all p < 0.001. CONCLUSION TBI constituted half of trauma transfers and 10% required surgery. Based on higher ICU admissions, mortality, and prevalence of AC/AP therapy requiring reversal, geriatric patients with TBI on anticoagulants/antiplatelets should be considered for direct trauma center admission.
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Affiliation(s)
- Joanna Wycech Knight
- Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA
- Broward Health Medical Center, Division of Trauma and Critical Care Services, Fort Lauderdale, Florida, USA
| | - Alexander A Fokin
- Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA
- Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, Florida, USA
| | - Nicholas Menzione
- Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA
| | - Sarah R Rabinowitz
- Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA
- Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sari A Viitaniemi
- Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA
| | - Ivan Puente
- Delray Medical Center, Division of Trauma and Critical Care Services, Delray Beach, Florida, USA
- Broward Health Medical Center, Division of Trauma and Critical Care Services, Fort Lauderdale, Florida, USA
- Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, Florida, USA
- Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, Miami, Florida, USA
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Al-Shareef AS, Thaqafi MA, Alzahrani M, Samman AM, AlShareef A, Alzahrani A, Alzahrani A, Rio A, Hariri B, Ramadan M. Traumatic Brain Injury Cases' Mortality Predictors, Association, and Outcomes in the Emergency Department at a Tertiary Healthcare Center in Saudi Arabia. Asian J Neurosurg 2022; 17:416-422. [DOI: 10.1055/s-0042-1750786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Aim Incidence of traumatic brain injury (TBI) in Saudi Arabia has been estimated to be 116 per 1,00,000 population as incidence of TBI continues to rise in our region. We aim to study the demographics, mortality predictors, and factors influencing the outcome of TBI cases in a tertiary care center in Jeddah, Saudi Arabia.
Materials and Methods We retrospectively collected data from all consecutive patients treated at the Emergency Department of King Abdulaziz Medical City including all acute TBI adult cases (>18 years) from 2016 to 2019. Logistic regression models were used to identify significant predictors of mortality. A total of 423 individuals with TBI were enrolled in the study. Nearly, half of them were in age group of 18 to 29 (40.77). Most patients were males (76.83%).
Results Injuries were most commonly mild-to-moderate TBI (73.83%). Road traffic accident was the most common mechanism of injury (49.7%) followed by fall (39.5%). Most common mode of transportation was private cars (47.57%). Most patient required less than or equal to24hours of admission (61.23%). A total of 30 (7%) died in the hospital all of which were male with no death cases reported among females.
Conclusion In conclusion, this study reports a mortality rate related to TBI that is among the lowest in the region. Injuries were male predominant with more balanced male to female ratio. Patients who were delivered to the hospital via private cars had an improved survival. These finding should be interpreted in the context of retrospective noncontrolled study design, and further future studies are encouraged to consolidate these findings.
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Affiliation(s)
- Ali S. Al-Shareef
- King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Majid Al Thaqafi
- King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Moajeb Alzahrani
- King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Afnan M. Samman
- King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah AlShareef
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Alzahrani
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ali Alzahrani
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ali Rio
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bassam Hariri
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Majed Ramadan
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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Jarvis S, Salottolo K, Berg GM, Carrick M, Caiafa R, Hamilton D, Banton K, Lieser M, Bar-Or D. Examining emergency medical services' prehospital transport times for trauma patients during COVID-19. Am J Emerg Med 2021; 44:33-37. [PMID: 33578329 PMCID: PMC7857109 DOI: 10.1016/j.ajem.2021.01.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Longer prehospital times were associated with increased odds for survival in trauma patients. The purpose of this study was to determine how the COVID-19 pandemic affected emergency medical services (EMS) prehospital times for trauma patients. Methods This retrospective cohort study compared trauma patients transported via EMS to six US level I trauma centers admitted 1/1/19–12/31/19 (2019) and 3/16/20–6/30/20 (COVID-19). Outcomes included: total EMS pre-hospital time (dispatch to hospital arrival), injury to dispatch time, response time (dispatch to scene arrival), on-scene time (scene arrival to scene departure), and transportation time (scene departure to hospital arrival). Fisher's exact, chi-squared, or Kruskal-Wallis tests were used, alpha = 0.05. All times are presented as median (IQR) minutes. Results There were 9400 trauma patients transported by EMS: 79% in 2019 and 21% during the COVID-19 pandemic. Patients were similar in demographics and transportation mode. Emergency room deaths were also similar between 2019 and COVID-19 [0.6% vs. 0.9%, p = 0.13].There were no differences between 2019 and during COVID-19 for total EMS prehospital time [44 (33, 63) vs. 43 (33, 62), p = 0.12], time from injury to dispatch [16 (6, 55) vs. 16 (7, 77), p = 0.41], response time [7 (5, 12) for both groups, p = 0.27], or on-scene time [16 (12−22) vs. 17 (12,22), p = 0.31]. Compared to 2019, transportation time was significantly shorter during COVID-19 [18 (13, 28) vs. 17 (12, 26), p = 0.01]. Conclusion The median transportation time for trauma patients was marginally significantly shorter during COVID-19; otherwise, EMS prehospital times were not significantly affected by the COVID-19 pandemic.
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Affiliation(s)
- Stephanie Jarvis
- ION Research, 501 East Hampden Ave, Englewood, CO 80113, United States of America
| | - Kristin Salottolo
- ION Research, 501 East Hampden Ave, Englewood, CO 80113, United States of America
| | - Gina M Berg
- Wesley Medical Center, 550 N Hillside Street, Wichita, KS 67214, United States of America.
| | - Matthew Carrick
- Medical City Plano, 3901 West 15(th) Street, Plano, TX 75075, United States of America.
| | - Rachel Caiafa
- St. Anthony Hospital, 11600 West 2(nd) Pl, Lakewood, CO 80228, United States of America
| | - David Hamilton
- Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907, United States of America
| | - Kaysie Banton
- Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States of America
| | - Mark Lieser
- Research Medical Center, 2330 East Meyer Blvd, Kansas City, MO 64132, United States of America.
| | - David Bar-Or
- ION Research, 501 East Hampden Ave, Englewood, CO 80113, United States of America.
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Möller A, Hunter L, Kurland L, Lahri S, van Hoving DJ. The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town. Afr J Emerg Med 2018; 8:89-94. [PMID: 30456155 PMCID: PMC6223589 DOI: 10.1016/j.afjem.2018.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/22/2017] [Accepted: 01/21/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa. METHODS The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of <0.05 was deemed significant. RESULTS The majority of patients were 19-44 year old males (n = 427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n = 343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a.m. In-hospital mortality (n = 18, 3.4%) was not significantly affected by transport method (p = 0.26), hospital arrival time (p = 0.22) or prehospital transport time intervals (all p-values >0.09). DISCUSSION Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.
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Affiliation(s)
- Anders Möller
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden
| | - Luke Hunter
- Khayelitsha Hospital, Private Bag X6, Khayelitsha, 7784 Cape Town, South Africa
| | - Lisa Kurland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden
- Department of Medical Sciences, Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
- Department of Emergency Medicine, Örebro University Hospital, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Sa'ad Lahri
- Khayelitsha Hospital, Private Bag X6, Khayelitsha, 7784 Cape Town, South Africa
| | - Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, Private Bag X1, Matieland, 7602 Stellenbosch, Cape Town, South Africa
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The impact of the patient's initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care. PLoS One 2018; 13:e0202215. [PMID: 30092090 PMCID: PMC6084954 DOI: 10.1371/journal.pone.0202215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excessive workload may impair patient safety. However, little is known about emergency care providers' workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient's initial NACA score and that workload is particularly high during CPR. METHODS NASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians' protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload. RESULTS In contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57). CONCLUSIONS Patients' initial NACA scores are associated with subjective workload. Workload was highest during CPR.
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Aljerian N, Alhaidar S, Alothman A, AlJohi W, Albaqami FA, Alghnam SA. Association between the mode of transport and in-hospital medical complications in trauma patients: findings from a level-I trauma center in Saudi Arabia. Ann Saudi Med 2018; 38:8-14. [PMID: 29419523 PMCID: PMC6074188 DOI: 10.5144/0256-4947.2018.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Saudi Arabia, injury is the leading cause of death. Even if nonfatal, the impact of injuries on population health is enormous, as thousands of young patients suffer permanent disabilities every year. Unlike in developed countries, private transportation (PT) is a common means to transport trauma patients. Outcome differences between patients transported via PT relative to emergency medical services (EMS) has not been previously explored. OBJECTIVES To evaluate the association between transportation mode and in-hospital complications among trauma patients. DESIGN Retrospective. SETTING Tertiary care center. PATIENTS AND METHODS The study included all patients (>=16 years), who were admitted following trauma. MAIN OUTCOME MEASURES The main outcome in the study was the occurrence of any medical complications including stroke, sepsis, myocardial infarction, pulmonary embolism, pneumonia, renal failure, acute respiratory distress syndrome, and cardiac arrest. RESULTS The 493 patients were relatively young (over two-thirds of the sample were 45 years old or younger) and over half the population sustained injuries due traffic crashes. More than half (58%) of patients arrived via private transportation. Regression analyses revealed that in-hospital complications following injuries were significantly lower among those who arrived via PT. However, after incorporating propensity score matching, we found no difference in hospital complications (OR=0.55, 95% CI 0.25-1.17). CONCLUSION Multiple factors may influence this unexpected finding, such as distance to health care set.tings, the belief that PT is faster or lack of knowledge of the EMS contact number. Further efforts are needed to raise awareness of the importance of using EMS to transport trauma patients to hospitals. Prevention programs to reduce traffic crashes may facilitate reduction in traumatic injuries and associated complications. LIMITATIONS Retrospective and conducted in one center only.
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Affiliation(s)
| | | | | | | | | | - Suliman Abdullah Alghnam
- Dr. Suliman Abdulah Alghnam Population Health, King Abdullah International Research Center, PO Box 22490, Riyadh 11426, Saudi Arabia T: +966-539468887, , ORCID: http://orcid.org/0000-0001-5817-0481
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Schneider F, Martin J, Hapfelmeier A, Jordan D, Schneider G, Schulz CM. The validity of linear and non-linear heart rate metrics as workload indicators of emergency physicians. PLoS One 2017; 12:e0188635. [PMID: 29190808 PMCID: PMC5708782 DOI: 10.1371/journal.pone.0188635] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background It has been shown that linear and non-linear heart rate variability (HRV) metrics are suitable to assess workload of anesthetists administering anesthesia. In pre-hospital emergency care, these parameters have not yet been evaluated. We hypothesized that heart rate (HR) and HRV metrics discriminate between differing workload levels of an emergency physician. Methods Electrocardiograms were obtained from 13 emergency physicians. Mean HR, ten linear and seven non-linear HRV metrics were analyzed. For each sortie, four different levels of workload were defined. Mixed-effects models and the area under the receiver operating characteristics curve (AUC) were used to test and quantify the HR and HRV metrics’ ability to discriminate between levels of workload. This was conducted for mean HR and each HRV metric as well as for groups of metrics (time domain vs. frequency domain vs. non-linear metrics). Results The non-linear HRV metric Permutation entropy (PeEn) discriminated best between the time before the alarm and primary patient care (AUC = 0.998, 1st rank of 18 HRV metrics). In contrast, AUC of the mean HR was low (0.558, 17th rank). In the multivariable approach, the non-linear HRV metrics provided a higher AUC (0.998) compared to the frequency domain (0.677) and to the time domain metrics (0.680). Conclusion Non-linear heart rate metrics and, specifically, PeEn provided good validity for the assessment of different levels of a physician’s workload in the setting of pre-hospital emergency care. In contradiction to earlier findings, the physicians’ mean HR was not a valid marker of workload.
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Affiliation(s)
- Frederick Schneider
- Department of Anesthesiology, Klinikum Rechts der Isar, Technische Universität München, München, Germany
- * E-mail:
| | - Jan Martin
- Department of Anesthesiology, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Denis Jordan
- Hochschule für Architektur, Bau und Geomatik, Institut Vermessung und Geoinformation, Fachhochschule Nordwestschweiz, Muttenz, Switzerland
| | - Gerhard Schneider
- Department of Anesthesiology, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Christian M. Schulz
- Department of Anesthesiology, Klinikum Rechts der Isar, Technische Universität München, München, Germany
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Prottengeier J, Jess N, Harig F, Gall C, Schmidt J, Birkholz T. Can we rely on out-of-hospital blood samples? A prospective interventional study on the pre-analytical stability of blood samples under prehospital emergency medicine conditions. Scand J Trauma Resusc Emerg Med 2017; 25:24. [PMID: 28259184 PMCID: PMC5336613 DOI: 10.1186/s13049-017-0371-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/27/2017] [Indexed: 11/18/2022] Open
Abstract
Background Prehospital intravenous access provides the opportunity to sample blood from an emergency patient at the earliest possible moment in the course of acute illness and in a state prior to therapeutic interventions. Our study investigates the pre-analytical stability of biomarkers in prehospital emergency medicine and will answer the question whether an approach of blood sampling out in the field will deliver valid laboratory results. Methods We prepared pairs of blood samples from healthy volunteers and volunteering patients post cardio-thoracic surgery. While one sample set was analysed immediately, the other one was subjected to a worse-than-reality treatment of 60 min time-lapse and standardized mechanical forces outside of the hospital through actual ambulance transport. We investigated 21 parameters comprising blood cells, coagulation tests, electrolytes, markers of haemolysis and markers of cardiac ischemia. Bland-Altman analysis was used to investigate differences between test groups. Differences between test groups were set against the official margins of test accuracy as given by the German Requirements for Quality Assurance of Medical Laboratory Examinations. Results Agreement between immediate analysis and our prehospital treatment is high as demonstrated by Bland-Altman plotting. Mechanical stress and time delay do not produce a systematic bias but only random inaccuracy. The limits of agreement for the tested parameters are generally within clinically acceptable ranges of variation and within the official margins as set by the German Requirements for Quality Assurance of Medical Laboratory Examinations. Discussion We subjected blood samples to a standardized treatment marking a worse-than-reality scenario of prehospital time delay and transport. Biomarkers including indicators of myocardial ischemia showed high pre-analytical stability. Conclusion We conclude the validity of blood samples from a prehospital environment. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0371-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Prottengeier
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Nicola Jess
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Frank Harig
- Department of Cardiac Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University, Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Schmidt
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Torsten Birkholz
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany
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Urgent Care as Intermediary Care: How Inbound and Outbound Transport Can Enhance Care of Community-Based Pediatric Emergencies. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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