Defining major trauma: a pre-hospital perspective using focus groups

Thompson, Lee; Hill, Michael A.; McMeekin, Peter; Shaw, Gary

doi:10.29045/14784726.2019.12.4.3.16

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Cervical spinal trauma/deformity was documented in 10% of OHCA hangings and 3% of non-OHCA hangings, none of whom had cervical collar application documented. The terminology used here may be one source of this potential disconnect, as cervical spinal trauma may have been documented due to the mechanism of injury rather than any physical evidence ( Thompson et al, 2019 ). The inconsistent use of cervical collars (7% overall), particularly in the OHCA population, needs further exploration.…”

Section: Discussionmentioning

confidence: 99%

Hangings attended by ambulance clinicians in the North East of England

Shaw

Thompson

McClelland

2021

British Paramedic Journal

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Introduction: Suicide rates have risen in England over the last decade and hanging, a highly lethal method of suicide, has been the most common method. Previous work in this area identified a lack of literature discussing emergency medical services (EMS) attendance at hangings. This article aims to describe hangings attended by EMS in the North East of England in order to inform future work in this area.Methods: A retrospective service evaluation was conducted using existing data from a comprehensive pre-hospital trauma audit database to describe patients with hanging documented in their records who were attended by ambulance clinicians between 1 December 2018 and 31 November 2020.Results: Hanging was recorded in 604 incidents. Most cases (n = 579/604) involved adults (aged 18 years or older) with a median age of 35 years (IQR 27‐45 years), who were male (n = 410/579, 71%). Just over half (n = 341/579, 59%) of adult hangings resulted in cardiac arrest and of these, 10% (n = 33/341) were resuscitated and survived to hospital admission. Threatened and non-fatal hangings appear to have increased dramatically in the latter half of 2020. Previous suicide attempts and mental health issues were frequently reported across this population.Conclusion: Hangings are a method of suicide which frequently result in a cardiac arrest. In the North East of England the ambulance service attends approximately one hanging per day and one fatal hanging every two days. When fatal hangings were resuscitated, pre-hospital outcomes were similar to other causes of cardiac arrest, highlighting that despite the traumatic nature of these cases resuscitation is not futile. In order to better understand this patient group and improve care, pre-hospital data need to be linked to data from other services such as mental health services and acute hospitals.

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Section: Discussionmentioning

confidence: 99%

Hangings attended by ambulance clinicians in the North East of England

Shaw

Thompson

McClelland

2021

British Paramedic Journal

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“…The survey was designed to reflect the outcomes of a literature review [ 12 ] and the output from three focus groups [ 17 ] the results and conclusions of which are in supplementary materials 3 and 4 . This included the domains: clinician factors, such as experience and exposure; patient factors, such as physiology, outcome measures and pre-trauma factors; and, situational factors, such as mechanism of injury.…”

Section: Methodsmentioning

confidence: 99%

Defining major trauma: a Delphi study

Thompson

Hill

Lecky

et al. 2021

Scand J Trauma Resusc Emerg Med

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Introduction Retrospective trauma scores are often used to categorise trauma, however, they have little utility in the prehospital or hyper-acute setting and do not define major trauma to non-specialists. This study employed a Delphi process in order to gauge degrees of consensus/disagreement amongst expert panel members to define major trauma. Method A two round modified Delphi technique was used to explore subject-expert consensus and identify variables to define major trauma through systematically collating questionnaire responses. After initial descriptive analysis of variables, Kruskal-Wallis tests were used to determine statistically significant differences (p < 0.05) in response to the Delphi statements between professional groups. A hierarchical cluster analysis was undertaken to identify patterns of similarity/difference of response. A grounded theory approach to qualitative analysis of data allowed for potentially multiple iterations of the Delphi process to be influenced by identified themes. Results Of 55 expert panel members invited to participate, round 1 had 43 participants (Doctor n = 20, Paramedic n = 20, Nurse n = 5, other n = 2). No consistent patterns of opinion emerged with regards to professional group. Cluster analysis identified three patterns of similar responses and coded as trauma minimisers, the middle ground and the risk averse. Round 2 had 35 respondents with minimum change in opinion between rounds. Consensus of > 70% was achieved on many variables which included the identification of life/limb threatening injuries, deranged physiology, need for intensive care interventions and that extremes of age need special consideration. It was also acknowledged that retrospective injury severity scoring has a role to play but is not the only method of defining major trauma. Various factors had a majority of agreement/disagreement but did not meet the pre-set criteria of 70% agreement. These included the topics of burns, spinal immobilisation and whether a major trauma centre is the only place where major trauma can be managed. Conclusion Based upon the output of this Delphi study, major trauma may be defined as: “Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy mechanisms in those rendered vulnerable by extremes of age”.

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“…2 Emergency Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK. 3 • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year…”

Section: Supplementary Informationmentioning

confidence: 99%

“…There is no universally accepted definition of major trauma, but the term is often used to denote serious injury that may result in permanent disability or death [ 1 ]. At patient level major trauma can describe injuries occurring in more than one body region, those with physiological compromise following injury or those that require admission to critical care [ 2 , 3 ]. The UK national trauma registry (TARN) reported that between 2008 and 2017 there was a two-fold increase in major trauma in over 60s at over 8000 patients during the report period, accounting for more than half of severely injured patients in the UK [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Provision of acute care pathways for older major trauma patients in the UK

et al. 2022

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Background The introduction of specific pathways of care for older trauma patients has been shown to decrease hospital length of stay and the overall rate of complications. The extent and scope of pathways and services for older major trauma patients in the UK is not currently known. Objective The primary objective of this study was to map the current care pathways and provision of services for older people following major trauma in the UK. Methods A cross-sectional survey of UK hospitals delivering care to major trauma patients (major trauma centres and trauma units). Data were collected on respondent and site characteristics, and local definitions of older trauma patients. To explore pathways for older people with major trauma, four clinical case examples were devised and respondents asked to complete responses that best illustrated the admission pathway for each. Results Responses from 56 hospitals were included in the analysis, including from 25 (84%) of all major trauma centres (MTCs) in the UK. The majority of respondents defined ‘old’ by chronological age, most commonly patients 65 years and over. The specialty team with overall responsibility for the patient in trauma units was most likely to be acute medicine or acute surgery. Patients in MTCs were not always admitted under the care of the major trauma service. Assessment by a geriatrician within 72 hours of admission varied in both major trauma centres and trauma units and was associated with increased age. Conclusions This survey highlights variability in the admitting specialty team and subsequent management of older major trauma patients across hospitals in the UK. Variability appears to be related to patient condition as well as provision of local resources. Whilst lack of standardisation may be a result of local service configuration this has the potential to impact negatively on quality of care, multi-disciplinary working, and outcomes.

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Defining major trauma: a pre-hospital perspective using focus groups

Cited by 9 publications

References 17 publications

Hangings attended by ambulance clinicians in the North East of England

Hangings attended by ambulance clinicians in the North East of England

Defining major trauma: a Delphi study

Provision of acute care pathways for older major trauma patients in the UK

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