Impact of the introduction of an integrated adult retrieval service on major trauma outcomes

Kennedy, Marcus P.; Gabbe, Belinda; McKenzie, Ben

doi:10.1136/emermed-2014-204376

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…Before and after PSM, we found that the mortality of patients after the trauma centre was built decreased from 13.51 to 11.01%, while the mortality of patients before the trauma centre was built increased, suggesting that there were some confounding factors that decreased the effect of trauma centre establishment. Indeed, trauma centres improve the outcomes of injured patients, and a developed trauma centre helps decrease the mortality rate of trauma by 13% [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

et al. 2023

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Background Little evidence suggests that trauma centres are associated with a lower risk of mortality in severely injured patients (Injury Severity Score (ISS) ≥16) with multiple injuries in China. The objective of this study was to determine the association between the establishment of trauma centres and mortality among severely injured patients with multiple injuries and to identify some risk factors associated with mortality. Methods A retrospective single-centre study was performed including trauma patients admitted to the First Affiliated Hospital of Nanchang University (FAHNU) between January 2016 and December 2021. To determine whether the establishment of a trauma centre was an independent predictor of mortality, logistic regression analysis and propensity score matching (PSM) were performed. Results Among 431 trauma patients, 172 were enrolled before the trauma centre was built, while 259 were included after the trauma centre was built. A higher frequency of older age and traffic accident injury was found in patients diagnosed after the trauma centre was built. The times for the completion of CT examinations, emergency operations and blood transfusions in the “after trauma centre” group were shorter than those in the “before trauma centre” group. However, the total expenditure of patients was increased. In the overall group, univariate and multivariate logistic regression analyses showed that a higher ISS was an independent predictor for worse mortality (OR = 17.859, 95% CI, 8.207–38.86, P < 0.001), while the establishment of a trauma centre was favourable for patient survival (OR = 0.492), which was also demonstrated by PSM. After determining the cut-off value of time for the completion of CT examination, emergency operation and blood transfusion, we found that the values were within the “golden one hour”, and it was better for patients when the time was less than the cut-off value. Conclusion Our study showed that for severely injured patients, the establishment of a trauma centre was favourable for a lower mortality rate. Furthermore, the completion of a CT examination, emergency surgery and blood transfusion in a timely manner and a lower ISS were associated with a decreased mortality rate.

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Section: Discussionmentioning

confidence: 99%

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

et al. 2023

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“…We will conduct a systematic review in accordance with Cochrane guidelines [14]. The protocol is presented using the structure suggested in Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 (Additional file 1) [15].…”

Section: Methodsmentioning

confidence: 99%

“…Statistical heterogeneity will be measured using I 2 statistics [14]. Heterogeneity will be interpreted as low from 0 to 40%, moderate from 30 to 60%, substantial from 50 to 90% and considerable from 75 to 100% [14].…”

Section: Methodsmentioning

confidence: 99%

Impact of trauma system structure on injury outcomes: a systematic review protocol

Moore

Champion²,

O’Reilly

et al. 2017

Syst Rev

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BackgroundInjury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of trauma care varies significantly across trauma systems and we know little about which components of trauma systems contribute to their effectiveness. The objective of the study described in this protocol is to systematically review evidence of the impact of trauma system components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization.MethodsWe will perform a systematic review of studies evaluating the association between at least one trauma system component (e.g. accreditation by a central agency, interfacility transfer agreements) and at least one injury outcome (e.g. mortality, disability, resource use). We will search MEDLINE, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, thesis holdings, key injury organisation websites and conference proceedings for eligible studies. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles. Methodological quality will be evaluated using elements of the ROBINS-I tool and the Cochrane risk of bias tool for non-randomized and randomized studies, respectively. Strength of evidence will be evaluated using the GRADE tool.DiscussionWe expect to advance knowledge on the components of trauma systems that contribute to their effectiveness. This may lead to recommendations on trauma system structure that will help policy-makers make informed decisions as to where resources should be focused. The review may also lead to specific recommendations for future research efforts.Systematic review registrationThis protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 28-06-2016. PROSPERO 2016:CRD42016041336 Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016041336.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0408-8) contains supplementary material, which is available to authorized users.

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“…Delays in treatment times highlight the need for a more rapid and reliable system for interfacility transport from facilities without PCI capabilities to comprehensive care centers. 75 , 76 Transfer policies work best in communities with a well‐developed “system‐of‐care” approach including engaged EMS agencies, hospitals, ambulance services, and emergency communications centers. 23 , 42 , 60 However, system challenges remain in both urban and rural areas (Table 3 ).…”

Section: The Stat Transfer Processmentioning

confidence: 99%

Emergency Interhospital Transfer of Patients With ST‐Segment–Elevation Myocardial Infarction: Call 9‐1‐1—The American Heart Association Mission: Lifeline Program

French

Gunderson

Travis

et al. 2022

JAHA

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The American Heart Association Mission: Lifeline program objectives are to improve the quality of care and outcomes for patients with ST‐segment–elevation myocardial infarction. Every minute of delay in treatment adversely affects 1‐year mortality. Transfer of patients safely and timely to hospitals with primary percutaneous coronary intervention capability is needed to improve outcomes. But treatment times continue to show delays, especially during interhospital transfers. A simple 3‐step process of an interhospital “Call 9‐1‐1” protocol may expedite this process. This STAT TRANSFER process uses a systems approach that considers diverse ways in which patients access care, how EMS responds and determines destinations, how referring hospital transfers are performed, urban and rural differences, and how receiving hospitals prepare for an incoming patient with ST‐segment–elevation myocardial infarction. This initiative suggests a strategy to reduce variability in interhospital transfer times using a STAT TRANSFER and a Call 9‐1‐1 process in a system of care that involves all stakeholders.

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Impact of the introduction of an integrated adult retrieval service on major trauma outcomes

Abstract: In a mature trauma system, an effective retrieval service can further reduce mortality and improve long-term outcomes.

Cited by 10 publications

References 14 publications

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

Impact of trauma system structure on injury outcomes: a systematic review protocol

Emergency Interhospital Transfer of Patients With ST‐Segment–Elevation Myocardial Infarction: Call 9‐1‐1—The American Heart Association Mission: Lifeline Program

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