Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

Watanabe, Hiroaki; Matsumoto, Ryo; Kuramoto, Shunsuke; Muronoi, Tomohiro; Oka, Kazuyuki; Shimojo, Yoshihide; Kidani, Akihiko; Hira, Eiji; Kawamura, Toshihiko

doi:10.1186/s13017-021-00377-w

Cited by 10 publications

(13 citation statements)

References 23 publications

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“…Notably, the use of diagnostic modalities such as computerized tomography (CT) and angiography is limited in patients with unstable vital signs. To overcome this, a hybrid emergency room (ER) equipped with a CT machine and operating theater has been established and used for unstable patients [ 3 ]. However, many trauma centers in Korea operate without a hybrid ER.…”

Section: Introductionmentioning

confidence: 99%

Correlation between the Injury Site and Trauma Mechanism in Severely Injured Patients with Blunt Trauma

Choi¹,

Jang²,

Kim³

et al. 2022

Emergency Medicine International

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Background. In patients with severe injury, predicting the injury site without using advanced diagnostic modalities can help formulate a diagnosis and treatment plan based on the suspected injury site. Objectives. This study aimed to determine the correlation between the injury site and trauma mechanism in severely injured patients with blunt trauma. Methods. We retrospectively analyzed the clinical characteristics—including age, sex, date of emergency room (ER) visit, time of injury, trauma mechanism (car accident, motorcycle accident, bicycle accident, pedestrian accident, fall, slipping and rolling down, crush injury, assault, and others), final diagnosis, injury severity score, abbreviated injury scale (AIS) score, and injury site—of 1,245 patients in a tertiary trauma center. Results. There was a strong correlation between certain injury sites and specific trauma mechanisms. In particular, most trauma mechanisms were associated with injury to the head and neck, as well as the chest, with a combined frequency of >40.0%. Moreover, when using one-way analysis of variance and Bonferroni’s post hoc tests, there were significant differences in AIS scores 1, 3, 4, and 5 for each trauma mechanism. Conclusion. Generally, when patients with severe injury present to the ER, the injury site can be predicted upon initial assessment based on the trauma mechanism. Based on our study, the injury site predicted by a specific mechanism should be checked repeatedly and additionally through physical examination and imaging tools. This can reduce misdiagnosis and help with accurate diagnosis and treatment.

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Section: Introductionmentioning

confidence: 99%

Correlation between the Injury Site and Trauma Mechanism in Severely Injured Patients with Blunt Trauma

Choi¹,

Jang²,

Kim³

et al. 2022

Emergency Medicine International

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“…The hybrid ER can be used for performing CT imaging, endovascular treatment, and emergency surgery including DCS without moving the patient, making it more effective for prompt diagnosis and treatment of hemodynamically unstable patients [1][2][3]. Hemodynamic instability in endogenous diseases can be caused by various factors such as hemorrhage, sepsis, and obstructive shock.…”

Section: Discussionmentioning

confidence: 99%

“…We were the rst in the world to introduce a rotary table hybrid ER system in 2017 [2]. Additionally, we reported that treatment in the hybrid ER contributed to a reduction in blood transfusion doses in patients with severe trauma [3].…”

Section: Introductionmentioning

confidence: 99%

“…Several reports, mostly published in Japan, have shown the effectiveness of a hybrid ER system in patients with trauma [1,[3][4][5][6][7][8][9][10][11][12]. However, most of these reports focus on trauma care, and to our knowledge, no reports have shown the usefulness of hybrid ER systems in non-traumatic diseases [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Effective Use of the Hybrid Emergency Room System in the Treatment of Patients with Non-Traumatic Critical Care Diseases: a retrospective, observational study

Matsumoto

Yamamoto

Kuramoto

et al. 2023

Preprint

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Background The hybrid emergency room (ER) system can provide resuscitation, computed tomography imaging, endovascular treatment, and emergency surgery, without moving the patient. Although several reports have demonstrated the effectiveness of hybrid ER for trauma conditions, none have demonstrated its usefulness for non-traumatic critical diseases. In this observational study, we aimed to determine the benefits of hyprid ER in the treatment of patients with non-traumatic conditions. Methods We retrospectively reviewed the clinical characteristics of patients with non-traumatic conditions treated in a hybrid ER from August 2017 to July 2022. Patients who underwent surgery, endoscopy, or interventional radiology (IR) in the hybrid ER were selected and pathophysiologically divided into a bleeding and non-bleeding group. The severity of illness, transfusion, and prognosis were compared among the groups using Fisher’s exact test. Multivariate logistic regression analysis was performed for confirming the relationship among prognosis, transfusion, and hemorrhagic conditions in patients who underwent endoscopy and IR. Results Among 726 patients with non-traumatic conditions treated in a hybrid ER system, 50 patients (6.9%) experienced cardiopulmonary arrest at or before admission to the hybrid ER, 301 (41.5%) were in shock, 126 (17.4%) received blood transfusions, 42 (5.8%) died within 24 h of admission to the hybrid ER, and 141 (19.4%) died in the hospital. Of the 726 patients, 39, 122, and 100 underwent surgery, endoscopy, and IR, respectively, in the hybrid ER. In the bleeding group, patients who underwent endoscopy and IR were more in shock and were administered significantly more blood transfusions than those who underwent surgery (endoscopy: p<0.0001 and IR: p=0.0005); however, no difference in prognosis was observed. Multivariate analysis in patients who underwent endoscopy showed a trend toward more in-hospital deaths in non-hemorrhagic conditions than in hemorrhagic conditions (odds ratio=3.833, 95% confidence interval: 0.884–16.621, p=0.073); however, no significant relationship with in-hospital death was observed for any of the adjusted variables. Conclusion Hybrid ER may be particularly effective for hemorrhagic conditions requiring endoscopic or IR hemostasis. The combination of diagnosis and treatment without patient transfer and appropriate transfusion strategies in a hybrid ER may improve outcomes in patients with non-traumatic diseases.

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“…A significant association was found between the hybrid ER and decreased mortality (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.29-0.85; p = 0.011) and reduced deaths from exsanguination (aOR, 0.17; 95% CI, 0.06-0.47; p = 0.001). The times to initiation of CT and emergency bleeding control procedures were also both shorter in the hybrid ER group versus the Conventional group (11 [8-16] vs. 26 [21][22][23][24][25][26][27][28][29][30][31][32] The first retrospective observational study on blood transfusion amounts during resuscitation in the hybrid ER was reported by Watanabe et al The amount of blood transfused was significantly lower in the hybrid ER versus nonhybrid ER group (whole blood: 8 vs. 14 units, p = 0.004; red blood cells: 2 vs. 6 units, p = 0.012; fresh frozen plasma: 6 vs. 9 units, p = 0.021). 29 This difference remained after propensity score matching (whole blood: 6 [4-16.5] vs. 28 units, p = 0.015; red blood cells: 2 [0-8.5] vs. 8 [2.75-26.5] units, p = 0.020; fresh frozen plasma: 6 [3.5-7.5] vs. 18 [5.5-27] units, p = 0.057).…”

Section: Clinical Experience With Severe Trauma In the Hybrid Ermentioning

confidence: 99%

Hybrid emergency room: Installation, establishment, and innovation in the emergency department

Wada

Maruyama

Yoshihara

et al. 2023

Acute Medicine & Surgery

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A novel trauma workflow system called the hybrid emergency room (Hybrid ER) that combines a sliding computed tomography (CT) scanning system with interventional radiology features was first installed in Osaka General Medical Center in 2011. The Hybrid ER enables CT diagnosis and emergency therapeutic interventions without transferring the patient to another examination room. In this article, the history of CT in trauma care, the world's first installation of the Hybrid ER, clinical experiences, and evidence for the Hybrid ER in trauma workflow and nontrauma fields are summarized, and the future and innovation of the Hybrid ER are reviewed.

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Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

Cited by 10 publications

References 23 publications

Correlation between the Injury Site and Trauma Mechanism in Severely Injured Patients with Blunt Trauma

Correlation between the Injury Site and Trauma Mechanism in Severely Injured Patients with Blunt Trauma

Effective Use of the Hybrid Emergency Room System in the Treatment of Patients with Non-Traumatic Critical Care Diseases: a retrospective, observational study

Hybrid emergency room: Installation, establishment, and innovation in the emergency department

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