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Wake E, Ranse J, Campbell D, Gabbe B, Marshall AP. Follow-up after major traumatic injury: a survey of services in Australian and New Zealand public hospitals. BMC Health Serv Res 2024; 24:630. [PMID: 38750458 PMCID: PMC11097478 DOI: 10.1186/s12913-024-11105-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: 10/20/2023] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Increased survival from traumatic injury has led to a higher demand for follow-up care when patients are discharged from hospital. It is currently unclear how follow-up care following major trauma is provided to patients, and how, when, and to whom follow-up services are delivered. The aim of this study was to describe the current follow-up care provided to patients and their families who have experienced major traumatic injury in Australia and New Zealand (ANZ). METHODS Informed by Donabedian's 'Evaluating the Quality of Medical Care' model and the Institute of Medicine's Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre. RESULTS Data were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up. CONCLUSION Follow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations.
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Affiliation(s)
- Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia.
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Don Campbell
- Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Belinda Gabbe
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
- Midwifery Education and Research Unit, Gold Coast University Hospital, Nursing, QLD, Australia
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Charyk Stewart T, Lakha N, Milton L, Bérubé M. Current trauma team activation processes at Canadian trauma centres: A national survey. Injury 2024; 55:111220. [PMID: 38012901 DOI: 10.1016/j.injury.2023.111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/20/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Trauma team activation (TTA) allows the provision of specialized and timely care to improve outcomes for severely injured patients. Limited information is available on the current state of TTA in Canadian trauma centres (TC). Study objectives were to describe TTA processes, data and reports, along with the challenges and successes from a national perspective. METHODS A mixed-methods, cross-sectional survey was undertaken with Canadian trauma leadership, utilizing a total population sampling strategy. The questionnaire, containing 108-items, was administered online between February-April 2022, utilizing a modified Dillman technique. Descriptive statistics and thematic analyses were performed. RESULTS Trauma leaders from 9 out of 10 provinces responded for a response rate of 68% (32/47). Two-thirds (67%) of respondents worked in adult TC; 63% in a level I center. A higher proportion of pediatric TC had a two-tiered TT response (60% pediatric; 35% adult). The most common criteria were neurologic compromise (100% one-level TTA) and hypotension (pediatric: 100% one-level, 100% tier 1; adult: 92% one-level, 86% tier 1). All one-level TTA included penetrating trauma criteria. One-third of respondents reported using TTA subgroup criteria for pediatric, pregnant, and/or geriatric patients. There was variability with disciplines responding to TTA, with largest, most comprehensive teams for tier 1. Two-thirds of TC review activation compliance (under/overtriage), while 55% focus on non-compliance and reasons for missed TTA. The most frequent challenges related to TTA practices were reliable data collection (60%) while successes included were the establishment of TTA guidelines to improve team compliance (33%) and RN initiated TTA. CONCLUSIONS Some TTA practices were similar among Canadian TC, while others showed variability. Findings provide opportunities for improvement, including a two-tier system, geriatric-specific criteria, and RN initiated TTA, and could help establish national standards and best practices. Compliance with standards has the potential to improve Canadian TTA practices and patient outcomes.
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Affiliation(s)
- Tanya Charyk Stewart
- London Health Sciences Centre, London, ON, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
| | - Nasira Lakha
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - 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, QC, Canada; Faculty of Nursing, Université Laval, Québec City, QC, Canada
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Wake E, Ranse J, Marshall AP. Scoping review of the literature to ascertain how follow-up care is provided to major trauma patients post discharge from acute care. BMJ Open 2022; 12:e060902. [PMID: 36691199 PMCID: PMC9462116 DOI: 10.1136/bmjopen-2022-060902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Survival following traumatic injury has increased, requiring ongoing patient follow-up. While longitudinal outcomes of trauma patients are reported, little is known about optimal delivery of follow-up service for this group. The aim of this scoping review was to identify and describe the structure, process and outcomes of postdischarge follow-up services for patients who sustained major trauma. EVIDENCE REVIEW This scoping review was conducted by searching CINAHL, MEDLINE and EMBASE databases. Articles were screened by three independent reviewers. The data of selected articles were organised in the categories of the Donabedian quality framework: structure, processes and outcomes. RESULTS Twenty-six articles were included after screening by title/abstract then full text against the inclusion/exclusion criteria; 92% (n=24) were from the USA.Follow-up services were provided by designated trauma centres and delivered by a mixture of health disciplines. Delivery of follow-up was multimodal (in person/telehealth). Protocols and guidelines helped to deliver follow-up care for non-physician led services.Ongoing health issues including missed injuries, pain and infection were identified. No standardised criteria were established to determine recipients, the timing or frequency of follow-up was identified. Patients who engaged with follow-up services were more likely to participate in other health services. Patients reported satisfaction with follow-up care. CONCLUSION There are wide variations in how follow-up services for major trauma patients are provided. Further evaluation should focus on patient, family and organisational outcomes. Identifying who is most likely to benefit, when and how follow-up care is delivered are important next steps in improving outcomes.
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Affiliation(s)
- Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Cast Campus, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Cast Campus, Queensland, Australia
- Nursing, Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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Howard A, West RM, Iball G, Panteli M, Baskshi MS, Pandit H, Giannoudis PV. Should Radiation Exposure be an Issue of Concern in Children With Multiple Trauma? Ann Surg 2022; 275:596-601. [PMID: 32740254 DOI: 10.1097/sla.0000000000004204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were 3-fold: first, establish the level of radiation exposure experienced by the pediatric trauma patients; second, model the level of risk of developing fatal carcinogenesis; and third, test whether pattern of injury was predictive of the level of exposure. SUMMARY BACKGROUND DATA There are certain conditions that cause children to be exposed to increased radiation, that is, scoliosis, where level of radiation exposure is known. The extent that children are exposed to radiation in the context of multiple traumas remains unclear. METHODS Patients below the age of 16 years and with an Injury Severity Score (ISS) ≥10, treated by a Major Trauma Center for the period January 2008 to December 2018 were identified. The following data were extracted for the year following the patient's injury: number, doses, and type of radiological examination.The sex and age of the patient was taken into account in the calculation of the risk of developing a carcinogenesis. RESULTS The median radiation dose of the 425 patients identified in the 12 months following injury, through both CT and radiographs, was 24.3 mSv. Modeling the predictive value of pattern of injury and other relevant clinical values, ISS was proportionately predictive of cumulative dose received. CONCLUSION A proportion of younger polytrauma patients were exposed to high levels of radiation that in turn mean an increased risk of carcinogenesis. However, the ISS, age, injury pattern, and length of hospital stay are predictive of both risks, enabling monitoring and patient advisement of the risks.
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Affiliation(s)
- Anthony Howard
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
| | - Robert M West
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Gareth Iball
- Clinical Scientist, Leeds Teaching Hospital, Leeds, Leeds, UK
| | - Michalis Panteli
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
- NIHR Clinical Lecturer, Leeds University, Leeds, UK
| | | | - Hemant Pandit
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
- Leeds University, Leeds, UK
| | - Peter V Giannoudis
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
- Leeds University, Leeds, UK
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Curtis K, Kennedy B, Lam MK, Mitchell RJ, Black D, Burns B, Dinh M, Holland AJ. Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia. Injury 2022; 53:61-68. [PMID: 33632604 DOI: 10.1016/j.injury.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care. METHODS This included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry. RESULTS There were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ2(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86-238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47-61) vs 115 (84-155) minutes (p <0.001)]. CONCLUSION Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; George Institute for Global Health, King St, Newtown, NSW, Australia.
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Mary K Lam
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia
| | - Deborah Black
- Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia; The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Michael Dinh
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, 1 Reserve Rd, St Leonards NSW 2065, Australia
| | - Andrew Ja Holland
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
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Koome G, Thuita F, Egondi T, Atela M. Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study. F1000Res 2021; 10:795. [PMID: 35186268 PMCID: PMC8829093 DOI: 10.12688/f1000research.54658.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.
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Affiliation(s)
- Gilbert Koome
- School of Public Health, University of Nairobi, Nairobi, 00200, Kenya
| | - Faith Thuita
- School of Public Health, University of Nairobi, Nairobi, 00200, Kenya
| | - Thaddaeus Egondi
- Strathmore Institute of Mathematical Sciences, Strathmore University, Nairobi, 00200, Kenya
| | - Martin Atela
- Peterhouse, University of Cambridge, Cambridge, Cambridge, UK
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Koome G, Thuita F, Egondi T, Atela M. Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study. F1000Res 2021; 10:795. [PMID: 35186268 PMCID: PMC8829093 DOI: 10.12688/f1000research.54658.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 09/18/2023] Open
Abstract
Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.
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Affiliation(s)
- Gilbert Koome
- School of Public Health, University of Nairobi, Nairobi, 00200, Kenya
| | - Faith Thuita
- School of Public Health, University of Nairobi, Nairobi, 00200, Kenya
| | - Thaddaeus Egondi
- Strathmore Institute of Mathematical Sciences, Strathmore University, Nairobi, 00200, Kenya
| | - Martin Atela
- Peterhouse, University of Cambridge, Cambridge, Cambridge, UK
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Koome G, Atela M, Thuita F, Egondi T. Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review. Trauma Surg Acute Care Open 2020; 5:e000530. [PMID: 33083557 PMCID: PMC7528423 DOI: 10.1136/tsaco-2020-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Africa accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa. METHODS A scoping review of published studies and grey literature was conducted. The search strategy utilized electronic databases comprising of Medline, Google Scholar, Pub-Med, Hinari and Cochrane Library. Screening and extraction of eligible studies was done independently and in duplicate. RESULTS A total of 782 study titles and or abstracts were screened. Of these, 32 underwent full text review. Out of the 32, 17 met the inclusion criteria for final review. The majority of studies were literature reviews (24%) and retrospective studies (23%). Retrospective and qualitative studies comprised 6% of the included studies, systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%), systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%). Reported post-trauma mortality ranged from 13% in Ghana to 40% in Nigeria. Reported preventable mortality is as high as 70% in South Africa, 60% in Ghana and 40% in Nigeria. Transport mode is the most studied health system factor (reported in 76% of the papers). Only two studies (12%) included access to pre-hospital care interventions aspects, nine studies (53%) included care providers aspects and three studies (18%) included aspects of referral pathways. The types of transport mode and referral pathway are the only factors significantly associated with post-trauma mortality, though the findings were mixed. None of the included studies reported significant associations between pre-hospital care interventions, care providers and post-trauma mortality. DISCUSSION Although research on health system factors and its influence on post-trauma mortality at the pre-hospital care level in Africa are limited, anecdotal evidence suggests that access to pre-hospital care interventions, the level of provider skills and referral pathways are important determinants of mortality outcomes. The strength of their influence will require well designed studies that could incorporate mixed method approaches. Moreover, similar reviews incorporating other LMICs are also warranted. Key Words: Health System Factors, Emergency Medical Services [EMS], Pre-hospital Care, Post-Trauma mortality, Africa.
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Affiliation(s)
- Gilbert Koome
- School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Martin Atela
- Peterhouse, University of Cambridge, Cambridge, UK
| | - Faith Thuita
- School of Public Health, University of Nairobi, Nairobi, Kenya
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Curtis K, Kennedy B, Holland AJA, Tall G, Smith H, Soundappan SSV, Burns B, Mitchell RJ, Wilson K, Loudfoot A, Dinh M, Lyons T, Gillen T, Dickinson S. Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool. Injury 2019; 50:1089-1096. [PMID: 30683570 DOI: 10.1016/j.injury.2019.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. METHODS Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. RESULTS A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2-12) years, the median ISS was 25 (IQR 16-30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89%). CONCLUSION The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, NSW, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia; The George Institute for Global Health, Sydney, Australia; Illawarra Health and Medical Research Institute, NSW, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, NSW, Australia.
| | - Andrew J A Holland
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | | | - Soundappan S V Soundappan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Brian Burns
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; NSW Ambulance, Sydney, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | | | - Michael Dinh
- NSW Institute of Trauma and Injury Management (ITIM), Australia; Sydney Local Health District, NSW, Australia
| | - Timothy Lyons
- Department of Forensic Medicine Newcastle, NSW, Australia
| | - Tona Gillen
- Lady Cilento Children's Hospital, Brisbane, Australia
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Curtis K, Mitchell R, McCarthy A, Wilson K, Van C, Kennedy B, Tall G, Holland A, Foster K, Dickinson S, Stelfox HT. Development of the major trauma case review tool. Scand J Trauma Resusc Emerg Med 2017; 25:20. [PMID: 28241880 PMCID: PMC5330157 DOI: 10.1186/s13049-017-0353-5] [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: 10/19/2016] [Accepted: 01/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. Methods Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater agreement was assessed for both the pilot and finalised versions of the tool. Results The final trauma case review tool contained ten sections, including patient factors (such as pre-existing conditions), presenting problem, a timeline of events, factors contributing to the care delivery problem (including equipment, work environment, staff action, organizational factors), positive aspects of care and the outcome of panel discussion. After refinement, the inter-rater reliability of the human factors and outcome components of the tool improved with an average 86% agreement between raters. Discussion This research developed an evidence-informed tool for use in paediatric trauma case review that considers both system safety and human factors to facilitate clinical review of trauma patient care. Conclusions This tool can be used to identify opportunities for improvement in trauma care and guide quality assurance activities. Validation is required in the adult population. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0353-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.,St George Clinical School, Faculty of Medicine, University of New South Wales, Gray St, Kogarah, NSW, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Amy McCarthy
- Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia
| | - Kellie Wilson
- NSW Institute of Trauma and Injury Management, Level 4, Sage Building, 67 Albert Avenue, Chatswood, NSW, Australia
| | - Connie Van
- Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.
| | - Belinda Kennedy
- Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia
| | - Gary Tall
- NSW Ambulance, Level 2, Sydney Ambulance Centre, Garden St Eveleigh, NSW, 2015, Australia
| | - Andrew Holland
- Sydney Medical School, The University of Sydney and The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kim Foster
- Sydney Nursing School, The University of Sydney, 88 Mallet Street, Camperdown, NSW, Australia.,NorthWestern Mental Health & School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Level 1 North, City Campus, The Royal Melbourne Hospital Grattan Street, Parkville, VIC, 3050, Australia
| | | | - Henry T Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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