Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters

Hsieh, Shang-Lin; Hsiao, Chien-Han; Chiang, Wen-Chu; Shin, Sang Do; Jamaluddin, Sabariah Faizah; Son, Do Ngoc; Hong, Ki Jeong; Sun, Jen Tang; Tsai, Weide; Chien, Ding-Kuo; Chang, Wenhan; Chen, Tse-Hao

doi:10.1007/s00068-021-01816-8

Cited by 27 publications

(26 citation statements)

References 26 publications

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“…In trauma imaging, timely diagnosis and intervention are crucial to patient survival and improved outcomes [ 4 ]. Despite the transformative power of PACS workstations on radiology workflow efficiencies, technical limitations nonetheless still exist which can delay image transfer from the CT scanner to the PACS.…”

Section: Discussionmentioning

confidence: 99%

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

et al. 2022

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Background Radiology trainees were uncomfortable going to the CT scanner to review trauma panscans and interacting with trauma surgeons. Objective This study aims to determine if radiology residents can be trained to accurately identify injuries requiring immediate surgical attention at the CT scanner. Methods A high-fidelity simulation model was created to provide an immersive training experience. Between February 2015 and April 2017, 62 class 1 trauma panscans were read at the CT scanner by 11 PGY-3 radiology residents. Findings made at the scanner were compared to resident preliminary and attending radiology reports and correlated with clinical outcomes. Timestamps were recorded and analyzed. Surveys were administered to assess the impact of training on radiology residents’ self-confidence and to assess trauma surgeons’ preference for radiology at the scanner. Significance level was set at p < 0.05. Results The mean time to provide results at the CT scanner was 11.1 min. Mean time for the preliminary report for CT head and cervical spine was 24.4 ± 9.8 min, and for the CT chest, abdomen, and pelvis was 16.3 ± 6.9 min. 53 traumatic findings on 62 panscans were identified at the scanner and confirmed at preliminary and final reports, for a concordance rate of 85%, compared to 72% for the control group. Radiology residents agreed or strongly agreed the training prepared them for trauma panscan reporting. Trauma surgeons shifted in favor of radiology presence at the scanner. Conclusion Radiology residents can be trained to accurately and rapidly identify injuries requiring immediate surgical attention at the CT scanner. Clinical impact These findings support the value-added of an in-person radiologist at the CT scanner for whole-body trauma panscans to facilitate timely detection of life-threatening injuries and improve professional relations between radiologists and trauma surgeons.

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Section: Discussionmentioning

confidence: 99%

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

et al. 2022

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“…Table 1 summarizes the characteristics of the included studies 9,16–38 . The two largest studies contributed 56.2% (5,716 of 10,168) of the included patients, 18,25 and 15 of 24 studies contained more than 100 patients.…”

Section: Resultsmentioning

confidence: 99%

The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review

Lamb

Tran

Lampron

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Uncontrolled bleeding is a common cause of preventable mortality in trauma. While it is intuitive that delays to hemostasis may lead to worse outcomes, the impacts of these delays remain incompletely explored. This systematic review aimed to characterize the extant definitions of delayed hemostatic intervention and to quantify the impacts of delays on clinical outcomes. METHODS We searched EMBASE, MEDLINE, and Web of Science from inception to August 2022. Studies defining “delayed intervention” and those comparing times to intervention among adults presenting to hospital with blunt or penetrating injuries who required major hemostatic intervention were eligible. The coprimary outcomes were mortality and the definition of delay to hemostasis used. Secondary outcomes included units of packed red blood cells received, length of stay in hospital, and length of stay in intensive care. RESULTS We identified 2,050 studies, with 24 studies including 10,168 patients meeting the inclusion criteria. The majority of studies were retrospective observational cohort studies, and most were at high risk of bias. A variety of injury patterns and hemostatic interventions were considered, with 69.6% of studies reporting a statistically significant impact of increased time to intervention on mortality. Definitions of delayed intervention ranged from 10 minutes to 4 hours. Conflicting data were reported for impact of time on receipt of blood products, while one study found a significant impact on intensive care length of stay. No studies assessed length of stay in hospital. CONCLUSION The extant literature is heterogeneous with respect to injuries included, methods of hemostasis employed, and durations of delay examined. While the majority of the included studies demonstrated a statistically significant relationship between time to intervention and mortality, an evidence-informed definition of delayed intervention for bleeding trauma patients at large has not been solidified. In addition, standardized research is needed to establish targets, which could reduce morbidity and mortality. LEVEL OF EVIDENCE Systematic Review; Level IV.

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“…Surgical studies also demonstrate the importance of timely resuscitation on outcomes. Decreasing time, even within 2 hr, to definitive care (i.e., surgical procedures) was associated with improved survival and functional outcomes (Hsieh et al, 2022). Trauma patients who experienced delays with emergent laparotomies were noted to have increased early and late inhospital mortality (Barbosa et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Impact of Trauma Resuscitation Emergency Care Nurse Deployment in Trauma Activations in a Rural Trauma Center

Holder

Leonard

Collins

et al. 2023

Journal of Trauma Nursing

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BACKGROUND: Although the role of a dedicated trauma nurse has been implemented in an urban setting, it has not been studied in the rural trauma setting. We instituted a trauma resuscitation emergency care (TREC) nurse role to respond to trauma activations at our rural trauma center. OBJECTIVE: This study aims to determine the impact of TREC nurse deployment on the timeliness of resuscitation interventions in trauma activations. METHODS: This pre- and postintervention study at a rural Level I trauma center compared the time to resuscitation interventions before (August 2018 to July 2019) and after (August 2019 to July 2020) deploying TREC nurses to trauma activations. RESULTS: A total of 2,593 participants were studied, of which 1,153 (44%) were in the pre-TREC group and 1,440 (56%) in the post-TREC group. After TREC deployment, the median (interquartile range [IQR]) emergency department times within the first hour decreased from 45 (31.23–53) to 35 (16–51) min (p = .013). The median (IQR) time to the operating room within the first hour decreased from 46 (37–52) to 29 (12–46) min (p = .001), and within the first 2 hr, decreased from 59 (43.8–86) to 48 (23–72) min (p = .014). CONCLUSION: Our study found that TREC nurse deployment improved resuscitation intervention timeliness during the first 2 hr (early phase) of trauma activations.

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Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters

Cited by 27 publications

References 26 publications

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review

Impact of Trauma Resuscitation Emergency Care Nurse Deployment in Trauma Activations in a Rural Trauma Center

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