1
|
Association between out-of-hospital cardiac arrest quality indicator and prehospital management and clinical outcomes for major trauma. Injury 2024; 55:111437. [PMID: 38403567 DOI: 10.1016/j.injury.2024.111437] [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: 08/17/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma. METHODS This retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea. We developed a prehospital ROSC prediction model to categorize EMS agencies into quartiles (Q1-Q4) based on the observed-to-expected (O/E) ROSC ratio for each EMS agency. We evaluated the national EMS protocol compliance of on-scene management according to O/E ROSC ratio quartile. The association between O/E ROSC ratio quartiles and trauma-related early mortality was determined in a multi-level logistic regression model by adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI). RESULTS Among 30,034 severe trauma patients, 4,836 were analyzed. Patients in Q4 showed the lowest early mortality rate (5.6 %, 5.5 %, 4.8 %, and 3.4 % in Q1, Q2, Q3, and Q4, respectively). In groups Q1 to Q4, increasing compliance with the national EMS on-scene management protocol (trauma center transport, basic airway management for patients with altered mentality, spinal motion restriction for patients with spinal injury, and intravenous access for patients with hypotension) was observed (p for trend <0.05). Multivariable multi-level logistic regression analysis showed significantly lower early mortality in Q4 than in Q1 (adjusted OR [95 % CI] 0.56 [0.35-0.91]). CONCLUSION Major trauma patients managed by EMS agencies with high success rates in achieving prehospital ROSC in non-traumatic OHCA were more likely to receive protocol-based care and exhibited lower early mortality.
Collapse
Affiliation(s)
- Hyouk Jae Lim
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| |
Collapse
|
2
|
Implementation of Upper Extremity Trauma Registry: A Pilot Study. World J Plast Surg 2023; 12:29-36. [PMID: 37220580 PMCID: PMC10200090 DOI: 10.52547/wjps.12.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/10/2023] [Indexed: 05/25/2023] Open
Abstract
Background Hand traumas are common in young men and their complications can have negative effects on their occupation and economic activities. On the other hand, most of the hand injuries are related to occupation accidents and thus necessitates preventive measures. The goal of a clinical registry is assisting epidemiologic surveys, quality improvement preventions. Methods This article explains the first phase of implementing a registry for upper extremity trauma. This phase includes recording of demographic data of patients. A questionnaire was designed. Contents include patients' characteristics, pattern of injury and past medical history in a minimal data set checklist. This questionnaire was filled in the emergency room by general practitioners. For 2 months the data were collected in paper based manner, then problems and obstacles were evaluated and corrected. During this period a web based software was designed. The registry was then ran for another 4 months using web based software. Results From 6.11.2019 to 5.3.2020, 1675 patients were recorded in the registry. Random check of recorded data suggests that accuracy of records was about 95.5%. Most of the missing data was related to associated injuries and job experience. Some mechanisms of injury seems to be related to Iran community and thus warrants special attention for preventive activities. Conclusion With a special registry personnel and supervision of plastic surgery faculties, an accurate record of data of upper extremity trauma is possible. The patterns of injury were remarkable and can be used for investigations and policy making for prevention.
Collapse
Affiliation(s)
| | - Ali Foroutan
- Hazrate Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Sherafat
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | | | | | - Hossein Akbari
- Hazrate Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Exploring the effectiveness of artificial intelligence, machine learning and deep learning in trauma triage: A systematic review and meta-analysis. Digit Health 2023; 9:20552076231205736. [PMID: 37822960 PMCID: PMC10563501 DOI: 10.1177/20552076231205736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
Background The development of artificial intelligence (AI), machine learning (ML) and deep learning (DL) has advanced rapidly in the medical field, notably in trauma medicine. We aimed to systematically appraise the efficacy of AI, ML and DL models for predicting outcomes in trauma triage compared to conventional triage tools. Methods We searched PubMed, MEDLINE, ProQuest, Embase and reference lists for studies published from 1 January 2010 to 9 June 2022. We included studies which analysed the use of AI, ML and DL models for trauma triage in human subjects. Reviews and AI/ML/DL models used for other purposes such as teaching, or diagnosis were excluded. Data was extracted on AI/ML/DL model type, comparison tools, primary outcomes and secondary outcomes. We performed meta-analysis on studies reporting our main outcomes of mortality, hospitalisation and critical care admission. Results One hundred and fourteen studies were identified in our search, of which 14 studies were included in the systematic review and 10 were included in the meta-analysis. All studies performed external validation. The best-performing AI/ML/DL models outperformed conventional trauma triage tools for all outcomes in all studies except two. For mortality, the mean area under the receiver operating characteristic (AUROC) score difference between AI/ML/DL models and conventional trauma triage was 0.09, 95% CI (0.02, 0.15), favouring AI/ML/DL models (p = 0.008). The mean AUROC score difference for hospitalisation was 0.11, 95% CI (0.10, 0.13), favouring AI/ML/DL models (p = 0.0001). For critical care admission, the mean AUROC score difference was 0.09, 95% CI (0.08, 0.10) favouring AI/ML/DL models (p = 0.00001). Conclusions This review demonstrates that the predictive ability of AI/ML/DL models is significantly better than conventional trauma triage tools for outcomes of mortality, hospitalisation and critical care admission. However, further research and in particular randomised controlled trials are required to evaluate the clinical and economic impacts of using AI/ML/DL models in trauma medicine.
Collapse
Affiliation(s)
- Oluwasemilore Adebayo
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Zunira Areeba Bhuiyan
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, UK
| |
Collapse
|
4
|
Occurrence and outcome of firework-related ocular injuries in Switzerland: A descriptive retrospective study. BMC Ophthalmol 2022; 22:296. [PMID: 35799154 PMCID: PMC9260982 DOI: 10.1186/s12886-022-02513-9] [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: 03/01/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Firework-related ocular injuries (FWROI) are a major cause of preventable visual impairment. This study aimed to analyze the occurrence and outcome of FWROI in Switzerland. Methods This retrospective multicenter study included patients with FWROI from seven centers in Switzerland from January 2009 to August 2020. Demographic information, type of injuries, medical and surgical treatments, the best corrected visual acuity (BCVA) at baseline and end of follow-up, occurrence and type of secondary complications, and duration of hospitalization were analyzed. Results A total of 105 patients (119 eyes) with a mean age of 27.1 ± 15.9 years were included in the study (71.4% male patients; 29.5% underage). Most injuries occurred around New Year’s Eve (32.4%) and the Swiss national holiday on 1 August (60.9%). The most common anterior segment findings were conjunctival or corneal foreign bodies (58%), whereas Berlin’s edema was the most common posterior segment finding (11.4%). Globe ruptures were found in four patients. The mean BCVA in all patients at first presentation was 0.4 ± 0.8 logMAR and improved to 0.3 ± 0.8 logMAR at last follow-up. A primary surgical intervention was performed in 48 eyes (40.3%). Hospitalization directly after the trauma was necessary for 18 patients for a mean of 5.8 ± 4.1 days, and a total of 4.9 ± 7.6 follow-up visits were needed. Conclusion This study provides the first data on FWROI in Switzerland, which are helpful for further preventive and educational programs and comparisons with other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02513-9.
Collapse
Affiliation(s)
- Ferhat Turgut
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland
| | - Alexandra Bograd
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Brida Jeltsch
- Department of Ophthalmology, University Hospital of Zurich, Zürich, Switzerland
| | - Adrian Weber
- Department of Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Schwarzer
- Department of Ophthalmology, Pallas Klinik Olten, Louis Giroud-Strasse 20, 4600, Olten, Switzerland
| | - Iulia M Ciotu
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
| | - Joao Amaral
- Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland
| | - Marcel N Menke
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland
| | - François Thommen
- Department of Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules-Gonin, Lausanne, Switzerland
| | - Tamer Tandogan
- Department of Ophthalmology, Pallas Klinik Olten, Louis Giroud-Strasse 20, 4600, Olten, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Pallas Klinik Olten, Louis Giroud-Strasse 20, 4600, Olten, Switzerland. .,Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. .,University of Bern, Bern, Switzerland.
| |
Collapse
|
5
|
Trauma Registry Data as a Policy-Making Tool: A Systematic Review on the Research Dimensions. Bull Emerg Trauma 2022; 10:49-58. [PMID: 35434165 PMCID: PMC9008338 DOI: 10.30476/beat.2021.91755.1286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/18/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To review the research dimensions of trauma registry data on health policy making. Methods: PubMed and EMBASE were searched until July 2020. Keywords were used on the search process included Trauma, Injury, Registry and Research, which were searched by using appropriate search strategies. The included articles had to: 1. be extracted from data related to trauma registries; 2- be written in English; 3- define a time period and a patient population; 4- preferably have more details and policy recommendations; and 5- preferably have a discussion on how to improve diagnosis and treatment. The results obtained from the included studies were qualitatively analyzed using thematic synthesis and comparative tables. Results: In the primary round of search, 19559 studies were retrieved. According to PRISMA statement and also performing quality appraisal process, 30 studies were included in the final phase of analysis. In the final papers’ synthesis, 14 main research domains were extracted and classified in terms of the policy implication and research priority. The domains with the highest frequency were “The relationship between trauma registry data and hospital care protocols for trauma patients” and “The causes of Disability Adjusted Life Years (DALYs) due to trauma”. Conclusion: Using trauma registry data as a tool for policy-making could be helpful in several ways, namely increasing the quality of patient care, preventing injuries and decreasing their number, figuring out the details of socioeconomic status effects, and improving the quality of researches in practical ways. Also, follow-up of patients after trauma surgery as one of the positive effects of the trauma registry can be the focus of attention of policy-making bodies.
Collapse
Affiliation(s)
| | - Farzan Berenjian
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Habibi
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute for Health Research and Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendedel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
A pilot trauma registry in Peshawar, Pakistan - A roadmap to decreasing the burden of injury - Quality improvement study. Ann Med Surg (Lond) 2021; 72:103137. [PMID: 34934485 PMCID: PMC8654792 DOI: 10.1016/j.amsu.2021.103137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/LOCAL PROBLEM In Pakistan, trauma is a significant public health issue accounting for the second leading cause of disability and fifth for healthy years of life lost. Well-developed trauma systems, utilizing trauma registries, have been proven to decrease morbidity and mortality from injuries, and helped to reduce the number of injured patients. In Pakistan, most data on injury are acquired through methods that are retrospective, incomplete, and open to recall bias. To that end, a trauma registry was piloted at the Lady Reading Hospital (LRH) in Peshawar, Pakistan to elucidate the importance of trauma registries in designing healthcare targeted quality improvement initiatives. INTERVENTION Upon receiving ethics approval, a twenty-five-point registry was piloted at the Lady Reading Hospital. METHODS The pilot implementation was carried out from May 9th to May 13th, 2018. RESULTS A total of 267 patients were included in the pilot registry. Motor vehicle collisions were the most prevalent cause of injury (46%). The other causes of injury included falls (24%), blunt assaults (9%), stabs/cuts (8%), gunshots (6%), crush injuries (3%), burns (2%), and blasts/landmines (2%). Most patients were treated in the trauma bay and required no further acute intervention (51%). CONCLUSION This 5-day pilot trauma registry was the first of its kind in Peshawar, Pakistan, and despite its short course, an immense amount of data was garnered on the epidemiology of injury in the region. Significantly, the data collected can already be used to develop evidence-based changes, which will effectively minimize the impact of trauma.
Collapse
Affiliation(s)
- Omaid Tanoli
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
- University of Toronto, Department of General Surgery, Toronto, On, Canada
| | - Hamza Ahmad
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
| | - Haider Khan
- Bacha Khan Medical College, Mardan, Khyber Pakhtunkhwa, Pakistan
| | | | - Awais Khan
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Alexandre Mikhail
- University of Toronto, Department of General Surgery, Toronto, On, Canada
| | - Dan Deckelbaum
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
| | - Tarek Razek
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
| |
Collapse
|
7
|
Prehospital care for traumatic spinal cord injury by first responders in 8 sub-Saharan African countries and 6 other low- and middle-income countries: A scoping review. Afr J Emerg Med 2021; 11:339-346. [PMID: 34141529 PMCID: PMC8187159 DOI: 10.1016/j.afjem.2021.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/14/2021] [Accepted: 04/30/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Traumatic spinal cord injury (TSCI) constitutes a considerable portion of the global injury burden, disproportionately affecting low- and middle-income countries (LMICs). Prehospital care can address TSCI morbidity and mortality, but emergency medical services are lacking in LMICs. The current standard of prehospital care for TSCI in sub-Saharan Africa and other LMICs is unknown. METHODS This review sought to describe the state of training and resources for prehospital TSCI management in sub-Saharan Africa and other LMICs. Articles published between 1 January 1995 and 1 March 2020 were identified using PMC, MEDLINE, and Scopus databases following PRISMA-ScR guidelines. Inclusion criteria spanned first responder training programs delivering prehospital care for TSCI. Two reviewers assessed full texts meeting inclusion criteria for quality using the Newcastle-Ottawa Scale and extracted relevant characteristics to assess trends in the state of prehospital TSCI care in sub-Saharan Africa and other LMICs. RESULTS Of an initial 482 articles identified, 23 met inclusion criteria, of which ten were set in Africa, representing eight countries. C-spine immobilization precautions for suspected TSCI patients is the most prevalent prehospital TSCI intervention for and is in every LMIC first responder program reviewed, except one. Numerous first responder programs providing TSCI care operate without C-collar access (n = 13) and few teach full spinal immobilization (n = 5). Rapid transport is most frequently reported as the key mortality-reducing factor (n = 11). Despite more studies conducted in the Southeast Asia/Middle East (n = 13), prehospital TSCI studies in Africa are more geographically diverse, but responder courses are shorter, produce fewer professional responders, and have limited C-collar availability. DISCUSSION Deficits in training and resources to manage TSCI highlights the need for large prospective trials evaluating alternative C-spine immobilization methods for TCSI that are more readily available across diverse LMIC environments and the importance of understanding resource variability to sustainably improve prehospital TSCI care.
Collapse
Affiliation(s)
- Zachary J. Eisner
- Washington University in St. Louis Dept. of Biomedical Engineering, United States of America
- Corresponding author.
| | - Peter G. Delaney
- University of Michigan Medical School, United States of America
- Michigan Center for Global Surgery, United States of America
| | - Patricia Widder
- Washington University in St. Louis Dept. of Biomedical Engineering, United States of America
| | - Ilyas S. Aleem
- University of Michigan Department of Orthopedic Surgery, United States of America
| | - Denise G. Tate
- University of Michigan Department of Physical Medicine and Rehabilitation, United States of America
| | - Krishnan Raghavendran
- Michigan Center for Global Surgery, United States of America
- University of Michigan Department of Surgery, Division of Acute Care Surgery, United States of America
| | - John W. Scott
- Michigan Center for Global Surgery, United States of America
- University of Michigan Department of Surgery, Division of Acute Care Surgery, United States of America
| |
Collapse
|
8
|
Surgical Rescue in a High-volume Urban Emergency General Surgery Service at a Middle-income Country. PANAMERICAN JOURNAL OF TRAUMA, CRITICAL CARE & EMERGENCY SURGERY 2021; 10:16-19. [PMID: 36196079 PMCID: PMC9529028 DOI: 10.5005/jp-journals-10030-1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: The capacity for prompt “rescue” from death in patients with complications has become an important marker of the quality of care since mortality and morbidity have been identified as incongruous indicators. This study aims to describe the incidence of “surgical rescue” failure and the outcomes of emergency general surgery (EGS) patients at a large academic medical center. Materials and methods: In our high-volume surgical hospital, an electronic EGS registry was developed to automatically capture in-hospital information and outcomes from the Electronic Medical Record (EMR). Surgical complications were included in an online application and automatically captured in the electronic EGS registry, and prospectively screened from June to July 2017 for acute EGS surgical patients from operative procedures. Results: A total of 501 patients (average age: 53.9 ± 20.9, 56.5% female) underwent 882 EGS procedures. Thirteen patients (2.6%) of the 501 patients required “surgical rescue”, mainly for uncontrolled sepsis (43%) and anastomotic leakage (30%). The surgical rescue failure rate (inability to prevent death after a surgical complication) was 15.4%. Patients requiring critical care (OR = 3.3, IC 95%: 1.04, 10.5), hospital admission (p = 0.038), and hospital LOS (days) (p = 0.004) were significantly higher for the surgical rescue patients than for those without complications. Conclusion: Surgical failure to rescue rate was similar among high-volume EGS services, as has recently been described in the United States. The latest development and implementation of an electronic automatic captured EGS registry database in our academic medical center will serve to build best practices for “surgical rescue” and drive quality improvement programs.
Collapse
Affiliation(s)
- Maria F Jimenez
- Department of Surgery, General Surgeon-Hospital Universitario Mayor, Universidad del Rosario, Bogota, Colombia
| | - Andrés Isaza-Restrepo
- Department of Surgery, General Surgeon-Hospital Universitario Mayor, Universidad del Rosario, Bogota, Colombia
| | - Danny Conde
- Department of Surgery, General Surgeon-Hospital Universitario Mayor, Universidad del Rosario, Bogota, Colombia
| | - Alex Arroyo
- Department of Surgery, Statistics Hospital Universitario Mayor, Bogota, Colombia
| | | | - Felipe Borda
- Department of Surgery, PGY-5 Hospital Universitario Mayor, Bogota, Colombia
| | - Daniel Colmenares
- Department of Surgery, PGY-5 Hospital Universitario Mayor, Bogota, Colombia
| | - Juan C Puyana
- Department of Surgery, University of Pittsburgh, Pennsylvania, USA
| |
Collapse
|
9
|
Development of a Prediction Model for Trauma Registry Chart Abstraction Time. J Trauma Nurs 2020; 27:369-373. [PMID: 33156254 DOI: 10.1097/jtn.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A Level I trauma center routinely faced challenges with meeting data submission deadlines and frequently struggled with a backlog of cases that limited opportunities for concurrent performance improvement. To provide a validated algorithm through which registry workload could be evaluated, the study institution designed a scientific model that predicted the amount of time required for chart abstraction on a patient-by-patient basis. METHODS As part of this quality improvement endeavor, registrars documented the amount of time required to complete each chart. A total of 600 patients' data were included by randomly selecting 150 patients from each of the 4 trauma registrars. Given that no previous study has examined the association of patient-related factors with chart abstraction time, study variables utilized to construct this predictive model were determined by the trauma program manager and the lead trauma registrar. RESULTS Multiple linear regression demonstrated that inhospital mortality; transfer from a referring facility; hospital stay; ventilator days; and number of complications, specialty consults, injuries, blood products, and procedures were significant predictors of chart abstraction time. The equation for the regression line for the multivariate regression was as follows: Y = 38.95 + 31.28 × mortality + 15.33 × referring facility + 4.68 × complications+3.55 × hospital stay + 3.33 × consults + 2.83 × diagnoses + 2.00 × ventilator days + 1.78 × blood products + 1.09 × procedures. CONCLUSIONS The merit of this prediction model is that it is based on patient-related variables and predicts time on a patient-by-patient basis. This innovative tool can be utilized by other trauma centers to evaluate registry productivity and identify opportunities for improvement retrospectively.
Collapse
|
10
|
Developing a National Integrated Road Traffic Injury Registry System: A Conceptual Model for a Multidisciplinary Setting. J Multidiscip Healthc 2020; 13:983-996. [PMID: 33061404 PMCID: PMC7520136 DOI: 10.2147/jmdh.s262555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Despite a high burden of traffic injuries, effective integrated or linked injury surveillance systems are rarely available in many low- and middle-income countries (LMICs). The aim of the current study was to define a conceptual model for developing a national integrated traffic injury registry in Iran. Methods A mult-method study financially and technically supported by the World Health Organization, Iranian Ministry of Health, Iranian Traffic Police, and the Iranian Legal Medicine Organization was conducted. A theoretical framework, forming the core conceptual components, was developed based on expert reviews. The preliminary conceptual model was developed by a panel of experts and tailored through a national workshop of 50 scientists, authorities and experts from nearly all sectors related to road safety promotion and injury management. It was then sent out to external reviewers in order to assess and improve the content validity of the model. Results The conceptual model was developed to have six components. These included 1) aims and core definitions; 2) content and core measurements; 3) data flow; 4) data collection routines; 5) organizational matrix; 6) implementation organization. The Haddon's matrix was adapted to be used as the theoretical framework in defining the content and data flow components of IRTIR. Five subcomponents were defined in the content and core measurements component with each having several subcategories. Each subcomponent/subcategory was finally divided into several item groups to guide defining the final data measurement variables. The data flow component was defined with six data sequence stations. Through the organizational matrix component, five major organizations relevant to road traffic safety were defined as core data production contributors. Some organizations also owned several sub-organizations which contributed in this regard. Conclusion It is concluded that the IRTIR conceptual model includes the required six components for developing a national integrated registry for Iran. Its main component called, content and core measurements, leads the researchers in developing final data collection tools in developing the national registry of road traffic injuries in Iran.
Collapse
Affiliation(s)
- Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,International Safe Community Certifying Center, Stockholm, Sweden
| | - Alireza Sadeghpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Michael Lowery Wilson
- University of Turku, Turku, Finland.,Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
| | - Alireza Ala
- Emergency Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Rahmani
- Emergency Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
11
|
Implementation of regional COVID-19 registry in Hormozgan (RCovidRH), Iran: Rationale and study protocol. Med J Islam Repub Iran 2020; 34:96. [PMID: 33316014 PMCID: PMC7722977 DOI: 10.34171/mjiri.34.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The rapid outbreak of COVID-19 has resulted in a global pandemic in 2020. Information sources such as disease registries through accessing quality, valid, accurate, and timely data empower researchers and health authorities to study and develop appropriate actions. Our study describes the protocol for implementation of regional COVID-19 registry in Hormozgan province (RCovidRH). Methods: We followed approved phases for the development of RCovidRH to cover the population in Hormozgan. Missioned to develop and implement the protocol, the registry's steering committee was made up of 10 members from subject fields of the registry at the core and 5 subgroups. The main purpose of the registry is to provide a comprehensive information profile of demographic, clinical, laboratory, imaging, and treatment data of confirmed and probable COVID-19 patients in Hormozgan. The data is retrospectively and prospectively collected. Case report form (CRF) was mainly based on International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) CRF. A web-based, 2-language software was also developed to facilitate data collection and storage. Data analysis is to be conducted with collaboration of clinical physicians, data-mining specialists, and epidemiologists after reaching appropriate sample size. Results: We included data related to demographic and identification, onset and admission, signs and symptoms at hospital admission, admission signs and symptoms, comorbidities, pathogen testing, assessment, laboratory, imaging, complications, treatment and medication, and outcomes. We found this registry was limited by incomplete clinical data for small fraction of outpatients, incomplete or inaccurate address by referred people due to fear of social rejection, delay in data entry at the facilities due to workload. Conclusion: This registry via organizing clinical and epidemiological COVID-19 data increases the potentiality of joint studies. Recognition and coordination of a registry is highly important to solve its limitations to collect data. Other universities and provinces can apply our model to develop COVID-19 registries or data sets for this disease.
Collapse
Affiliation(s)
- Farid Khorrami
- Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehraban Shahi
- Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nasrin DavariDolatabadi
- Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nader Alishan Karami
- Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi HasaniAzad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Fereshteh Jafariyan
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Developing a trauma registry in a middle-income country - Botswana. Afr J Emerg Med 2020; 10:S29-S37. [PMID: 33318899 PMCID: PMC7723909 DOI: 10.1016/j.afjem.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Botswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals. METHODS A cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 - stakeholders' consultation and trauma registry prototype was designed. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype. RESULTS The pre-hospital road traffic accident data are collected using hard copy forms and some of these data were transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data were also partially stored as hard copies and some data are stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals. CONCLUSION Electronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools.
Collapse
|
13
|
Temporal trends in patient characteristics, injury mechanisms and outcomes in pediatric trauma admissions between 2010 and 2017. Am J Surg 2020; 220:468-475. [DOI: 10.1016/j.amjsurg.2019.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
|
14
|
Establishing injury surveillance in emergency departments in Nepal: protocol for mixed methods prospective study. BMC Health Serv Res 2020; 20:433. [PMID: 32423459 PMCID: PMC7236178 DOI: 10.1186/s12913-020-05280-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background Globally, injuries cause more than 5 million deaths annually, a similar number to those from HIV, Tuberculosis and Malaria combined. In people aged between 5 and 44 years of age trauma is the leading cause of death and disability and the burden is highest in low- and middle-income countries (LMICs). Like other LMICs, injuries represent a significant burden in Nepal and data suggest that the number is increasing with high morbidity and mortality. In the last 20 years there have been significant improvements in injury outcomes in high income countries as a result of organised systems for collecting injury data and using this surveillance to inform developments in policy and practice. Meanwhile, in most LMICs, including Nepal, systems for routinely collecting injury data are limited and the establishment of injury surveillance systems and trauma registries have been proposed as ways to improve data quality and availability. Methods This study will implement an injury surveillance system for use in emergency departments in Nepal to collect data on patients presenting with injuries. The surveillance system will be introduced in two hospitals and data collection will take place 24 h a day over a 12-month period using trained data collectors. Prospective data collection will enable the description of the epidemiology of hospital injury presentations and associated risk factors. Qualitative interviews with stakeholders will inform understanding of the perceived benefits of the data and the barriers and facilitators to embedding a sustainable hospital-based injury surveillance system into routine practice. Discussion The effective use of injury surveillance data in Nepal could support the reduction in morbidity and mortality from adult and childhood injury through improved prevention, care and policy development, as well as providing evidence to inform health resource allocation. This study seeks to test a model of injury surveillance based in emergency departments and explore factors that have the potential to influence extension to additional settings.
Collapse
|
15
|
Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania. Inj Epidemiol 2020; 7:15. [PMID: 32354375 PMCID: PMC7193390 DOI: 10.1186/s40621-020-00244-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Trauma registries (TRs) are essential to informing the quality of trauma care within health systems. Lack of standardised trauma documentation is a major cause of inconsistent and poor availability of trauma data in most low- and middle-income countries (LMICs), hindering the development of TRs in these regions. We explored health providers' perceptions on the use of a standardised trauma form to record trauma patient information in Tanzania. METHODS An exploratory qualitative research using a semi-structured interview guide was carried out to purposefully selected key informants comprising of healthcare providers working in Emergency Units and surgical disciplines in five regional hospitals in Tanzania. Data were analysed using a thematic analysis approach to identify key themes surrounding potential implementation of the standardised trauma form. RESULTS Thirty-three healthcare providers participated, the majority of whom had no experience in the use of standardised charting. Only five respondents had prior experience with trauma forms. Responses fell into three themes: perspectives on the concept of a standardised trauma form, potential benefits of a trauma form, and concerns regarding successful and sustainable implementation. CONCLUSION Findings of this study revealed wide healthcare provider acceptance of moving towards standardised clinical documentation for trauma patients. Successful implementation likely depends on the perceived benefits of using a trauma form as a tool to guide clinical management, standardise care and standardise data reporting; however, it will be important moving forward to factor concerns brought up in this study. Potential barriers to successful and sustainable implementation of the form, including the need for training and tailoring of form to match existing resources and knowledge of providers, must be considered.
Collapse
Affiliation(s)
- Hendry R. Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nathanael Sirili
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ellen Weber
- Emergency Department, University of California, San Francisco, CA USA
| | - Timothy J. Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Teri A. Reynolds
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Unit Head, Clinical Services and Systems, Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Lee A. Wallis
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
16
|
Design, implementation and long-term follow-up of a context specific trauma training course in Uganda: Lessons learned and future directions. Am J Surg 2020; 219:263-268. [DOI: 10.1016/j.amjsurg.2019.10.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/08/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022]
|
17
|
Recovery of knee extension and incidence of extension deficits following anterior cruciate ligament injury and treatment: a systematic review protocol. J Orthop Surg Res 2019; 14:88. [PMID: 30922410 PMCID: PMC6437951 DOI: 10.1186/s13018-019-1127-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/12/2019] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Knee extension deficit or loss of extension (LOE) is a potential complication following ACL reconstruction (ACLR); however, the change in postoperative knee extension during rehabilitation is not well defined. The aim of this review is to establish the trajectory of knee extension recovery and incidence of knee extension deficit during rehabilitation after ACL rupture. METHODS AND ANALYSIS A systematic search will be conducted in MEDLINE, Embase, Cochrane Library, Scopus, SPORTDiscus, and relevant trials databases of English language papers in publication as of May 2018, with no restrictions on publication year applied. References will be screened and assessed for eligibility by two independent reviewers as per the PRISMA guidelines. Cohort, cross-sectional or case-controlled studies will be included for the analysis. Data extraction will be conducted using a predefined template and quality of evidence assessed. Statistical summaries and meta-analyses will be performed as necessary. ETHICS AND DISSEMINATION This review will provide clearer definitions for the measurement and interpretation of postoperative knee extension and establish its natural history after ACL reconstruction. Evidence of the incidence and factors associated with loss of extension will be identified. The findings of this systematic review will be disseminated in peer-reviewed journals and presented at national/international conferences. TRIAL REGISTRATION The protocol was registered on the PROSPERO international prospective register of systematic reviews prior to commencement (registration number CRD42018092295 ).
Collapse
Affiliation(s)
| | | | | | - Garry Kirwan
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD Australia
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Binglong Lee
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD Australia
| | - Christopher Bell
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD Australia
| |
Collapse
|