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Benhamed A, Batomen B, Boucher V, Yadav K, Isaac CJ, Mercier E, Bernard F, Blais-L'écuyer J, Tazarourte K, Emond M. Relationship between systolic blood pressure and mortality in older vs younger trauma patients - a retrospective multicentre observational study. BMC Emerg Med 2023; 23:105. [PMID: 37726708 PMCID: PMC10508012 DOI: 10.1186/s12873-023-00863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The population of older trauma patients is increasing. Those patients have heterogeneous presentations and need senior-friendly triaging tools. Systolic blood pressure (SBP) is commonly used to assess injury severity, and some authors advocated adjusting SBP threshold for older patients. We aimed to describe and compare the relationship between mortality and SBP in older trauma patients and their younger counterparts. METHODS We included patients admitted to three level-I trauma centres and performed logistic regressions with age and SBP to obtain mortality curves. Multivariable Logistic regressions were performed to measure the association between age and mortality at different SBP ranges. Subgroup analyses were conducted for major trauma and severe traumatic brain injury admissions. RESULTS A total of 47,661 patients were included, among which 12.9% were aged 65-74 years and 27.3% were ≥ 75 years. Overall mortality rates were 3.9%, 8.1%, and 11.7% in the groups aged 16-64, 65-74, and ≥ 75 years, respectively. The relationship between prehospital SBP and mortality was nonlinear (U-shape), mortality increased with each 10 mmHg SBP decrement from 130 to 50 mmHg and each 10-mmHg increment from 150 to 220 mmHg across all age groups. Older patients were at higher odd for mortality in all ranges of SBP. The highest OR in patients aged 65-74 years was 3.67 [95% CI: 2.08-6.45] in the 90-99 mmHg SBP range and 7.92 [95% CI: 5.13-12.23] for those aged ≥ 75 years in the 100-109 mmHg SBP range. CONCLUSION The relationship between SBP and mortality is nonlinear, regardless of trauma severity and age. Older age was associated with a higher odd of mortality at all SBP points. Future triage tools should therefore consider SBP as a continuous rather than a dichotomized predictor.
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Affiliation(s)
- Axel Benhamed
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada
- Hospices Civils de Lyon, Service d'Accueil des Urgences - SAMU 69, Centre Hospitalier Universitaire Edouard Herriot, Lyon, 69003, France
| | - Brice Batomen
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Valérie Boucher
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Eric Mercier
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Francis Bernard
- Critical Care Unit, Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
| | - Julien Blais-L'écuyer
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Karim Tazarourte
- Hospices Civils de Lyon, Service d'Accueil des Urgences - SAMU 69, Centre Hospitalier Universitaire Edouard Herriot, Lyon, 69003, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, 69003, France
| | - Marcel Emond
- CHU de Québec-Université Laval Research Centre, Québec, Québec, Canada.
- Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, Québec, Canada.
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Truchot J, Benhamed A, Batomen B, Boucher V, Malo C, Chauny JM, de Champlain F, Émond M. Trauma team leader and early mortality: An interrupted time series analysis. Am J Emerg Med 2022; 62:32-40. [DOI: 10.1016/j.ajem.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022] Open
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Carrillo I, López-Pineda A, García-Díaz S, López A, Valencia Muntalà L, Juanola X, Zarco P, Ignacio E, Mira JJ. Proposals for the incorporation of the nursing role in the certification of axial spondyloarthritis units. Literature review and expert consensus. Reumatol Clin (Engl Ed) 2022; 18:580-586. [PMID: 35469782 DOI: 10.1016/j.reumae.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units. METHODS A systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of three rheumatology nurses to determine elements that should be considered in future revisions of certification standards. RESULTS The systematic review yielded five papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation for monitoring the stable patient, registry of patient-reported outcome measures and e-consultation. CONCLUSIONS The literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role.
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Affiliation(s)
- Irene Carrillo
- Departamento de Psicología de la Salud, Universidad Miguel Hernández de Elche, Elche, Spain.
| | - Adriana López-Pineda
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan (Alicante), Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), San Juan (Alicante), Spain
| | - Silvia García-Díaz
- Departamento de Reumatología, Complex Hospitalari Moisès Broggi, CSI, Sant Joan Despí (Barcelona), Spain
| | - Amparo López
- Departamento de Enfermería de Práctica Avanzada, CEIMI, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lídia Valencia Muntalà
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Hospitalet de Llobregat (Barcelona), Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), Spain
| | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Emilio Ignacio
- Gestión Sanitaria y Calidad Asistencial, Universidad de Cádiz, Cádiz, Spain
| | - José Joaquín Mira
- Departamento de Psicología de la Salud, Universidad Miguel Hernández de Elche, Elche, Spain; Departamento de Salud Alicante-Sant Joan d'Alacant, San Juan (Alicante), Spain
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Sand-Svartrud AL, Berdal G, Azimi M, Bø I, Dager TN, Eppeland SG, Fredheim GO, Hagland AS, Klokkeide Å, Linge AD, Sexton J, Tennebø K, Valaas HL, Mjøsund K, Dagfinrud H, Kjeken I. Associations between quality of health care and clinical outcomes in patients with rheumatic and musculoskeletal diseases: a rehabilitation cohort study. BMC Musculoskelet Disord 2022; 23:357. [PMID: 35428256 PMCID: PMC9011960 DOI: 10.1186/s12891-022-05271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The quality of provided health care may be an important source of variation in rehabilitation outcomes, increasing the interest in associations between quality indicators (QIs) and improved patient outcomes. Therefore, we examined the associations between the quality of rehabilitation processes and subsequent clinical outcomes among patients with rheumatic and musculoskeletal diseases (RMDs). Methods In this multicentre prospective cohort study, adults with RMDs undergoing multidisciplinary rehabilitation at eight participating centres reported the quality of rehabilitation after 2 months and outcomes after 2, 7, and 12 months. We measured perceived quality of rehabilitation by 11 process indicators that cover the domains of initial assessments, patient participation and individual goal-setting, and individual follow-up and coordination across levels of health care. The patients responded “yes” or “no” to each indicator. Scores were calculated as pass rates (PRs) from 0 to 100% (best score). Clinical outcomes were goal attainment (Patient-Specific Functional Scale), physical function (30 s sit-to-stand test), and health-related quality of life (EuroQoL 5D-5L). Associations between patient-reported quality of care and each outcome measure at 7 months was analysed by linear mixed models. Results A total of 293 patients were enrolled in this study (mean age 52 years, 76% female). Primary diagnoses were inflammatory rheumatic disease (64%), fibromyalgia syndrome (18%), unspecific neck, shoulder, or low back pain (8%), connective tissue disease (6%), and osteoarthritis (4%). The overall median PR for the process indicators was 73% (range 11–100%). The PR was lowest (median 40%) for individual follow-up and coordination across levels of care. The mixed model analyses showed that higher PRs for the process indicators were not associated with improved goal attainment or improved physical function or improved health-related quality of life. Conclusions The quality of rehabilitation processes was not associated with important clinical outcomes. An implication of this is that measuring only the outcome dimension of quality may result in incomplete evaluation and monitoring of the quality of care, and we suggest using information from both the structure, process, and outcome dimensions to draw inferences about the quality, and plan future quality initiatives in the field of complex rehabilitation. Trial registration The study is part of the larger BRIDGE trial (ClinicalTrials.gov NCT03102814).
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Hinchcliff R. Advancing the accreditation economy: a critical reflection. Int J Qual Health Care 2021; 33:6432126. [PMID: 34865015 DOI: 10.1093/intqhc/mzab154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Reece Hinchcliff
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, QUT Kelvin Grove Campus, Kelvin Grove, QLD 4059, Australia.,Centre for Health Management, University of Technology Sydney, Level 10, 235 Jones Street, Ultimo, Sydney, NSW 2007, Australia
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