CHOP protocol: streamlining access to definitive intervention for major trauma victims

Kang, Min Li; Goo, Jerry Tiong Thye; Lee, Dong Hoon

doi:10.11622/smedj.2020113

Cited by 2 publications

(2 citation statements)

References 51 publications

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“…The hospital’s trauma activation protocols consist of a first-line trauma activation that is initiated on presentation for patients who have suspected multisystem polytrauma or high-speed injury, and a second-line trauma activation protocol initiated for patients who are haemodynamically unstable and mandate immediate attention by consultant specialists for intervention. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

Impact of nationwide COVID-19 lockdown on workload and injury patterns of major trauma cases in a regional trauma centre in Singapore

Kang

Lim

Lee

et al. 2021

Singapore Medical Journal

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Introduction: Singapore instituted lockdown measures from 7th February 2020 to 1st June 2020 in response to the COVID-19 pandemic. Methods: Retrospective analysis of cases from the national trauma registry was carried out comparing the lockdown period (7th February 2020 to 1st June 2020) to the pre-lockdown period (7th February 2019 to 1st June 2019). Data extracted included the volume of Tier 1 (ISS >15) and Tier 2 (ISS 9-15) cases and epidemiology. Subgroup analysis was performed for Tier 1 patient outcomes. Results: Trauma volume decreased by 19.5% with a 32% drop in Tier 1 cases. Road traffic and workplace accidents decreased by 50% (p<0.01) while interpersonal violence showed an increase of 37.5% (p=0.34). There was an 18.1% decrease in usage of trauma workflows (p=0.01), with an increase in time to intervention for Tier 1 patients from 88 to 124 minutes (p =0.22). Discharge to community facilities decreased from 31.4% to 17.1% (p < 0.05). There was no increase in inpatient mortality, length of stay in critical care, or length of stay overall. Conclusion: There was an overall decrease in major trauma cases during the lockdown period, particularly road traffic accidents and worksite injuries and a relative increase in interpersonal violence. Redeployment of manpower and hospital resources may have contributed to decreased usage of trauma workflows and community facilities. In the event of further lockdowns it is necessary to plan for trauma coverage and maintain use of workflows to facilitate early intervention.

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Section: Introductionmentioning

confidence: 99%

Impact of nationwide COVID-19 lockdown on workload and injury patterns of major trauma cases in a regional trauma centre in Singapore

Kang

Lim

Lee

et al. 2021

Singapore Medical Journal

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“…Analysis of the first 10 cases of CHOP protocol activation reported an average time of 73 minutes from the time of patient's arrival at ED to transfer to OT or IR suite. 4 The activation of Code Crimson at Auckland City Hospital is currently based on the Assessment of Blood Consumption (ABC) Score, which is validated to predict the need for a massive transfusion protocol (MTP) in patients with major haemorrhage. 5 The patient should meet 2 out of 4 criteria of ABC score for activation, namely, (1) heart rate >120 beats per minute, (2) systolic blood pressure <90mmHg, (3) penetrating injuries to head, neck, chest, abdomen and/or proximal extremities, and (4) positive focused abdominal sonography in trauma (FAST) imaging indicating haemoperitoneum or haemopericardium.…”

mentioning

confidence: 99%

Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore

Pothiawala

Friedericksen

Civil

2022

Ann Acad Med Singap

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“Trauma activation” is a process adopted across all emergency departments of public healthcare institutions in Singapore, with the aim of rapidly mobilising personnel and resources to care for patients with major trauma. A subset of trauma patients with exsanguinating haemorrhage has a particularly high mortality rate, and they require an additional response beyond the usual trauma activation for definitive haemorrhage control. To address this need, Code Crimson has been developed at Auckland City Hospital in New Zealand and other jurisdictions as a step-up response. This is aimed at early activation of the massive transfusion protocol for haemostatic resuscitation, involvement of additional multidisciplinary teams for rapid decision-making, and expediting definitive haemorrhage control. At present, there is no protocol for activation of Code Crimson in Singapore. Code Crimson may be effective in Singapore, as it has been in other jurisdictions, to reduce morbidity and mortality in major trauma patients with severe haemorrhage. Keywords: Code Crimson, definitive control, emergency department, haemorrhage, massive transfusion protocol

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CHOP protocol: streamlining access to definitive intervention for major trauma victims

Cited by 2 publications

References 51 publications

Impact of nationwide COVID-19 lockdown on workload and injury patterns of major trauma cases in a regional trauma centre in Singapore

Impact of nationwide COVID-19 lockdown on workload and injury patterns of major trauma cases in a regional trauma centre in Singapore

Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore

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