Mortality in Canadian Trauma Systems

Moore, Lynne; Evans, David C.; Hameed, S. Morad; Yanchar, Natalie; Stelfox, Henry T.; Simons, Richard K.; Kortbeek, John B.; Bourgeois, G; Clément, Julien; Lauzier, François; Nathens, Avery B.; Turgeon, Alexis F.

doi:10.1097/sla.0000000000001614

Cited by 68 publications

(50 citation statements)

References 21 publications

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“…In situations when oral agents cannot be administered or there are concerns about absorption, the use of an intravenous glycoprotein IIb/IIIa inhibitor or the recently available intravenous P2Y 12 inhibitor cangrelor can be considered.…”

Section: Suggestions For Clinical Practicementioning

confidence: 99%

“…In addition, studies have demonstrated poor gastrointestinal absorption of these medications in the setting of MI, a problem that may be exacerbated in CS. 188 The ISAR-SHOCK (Efficacy Study of LV Assist Device to Treat Patients With Cardiogenic Shock) registry, which included patients with CS undergoing PCI who had a platelet function assessment after receiving an oral P2Y 12 inhibitor, reported that prasugrel was associated with a nonsignificant reduction in 30-day mortality. 188 In a secondary analysis of the IABP-SHOCK II trial, there was no difference in mortality or bleeding events in a comparison of clopidogrel, prasugrel, and ticagrelor in patients with acute MI complicated by CS.…”

Section: Antithrombotic Pharmacotherapy Adjuncts To Pcimentioning

confidence: 99%

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Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,343

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Suggestions For Clinical Practicementioning

confidence: 99%

Section: Antithrombotic Pharmacotherapy Adjuncts To Pcimentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,343

1,165

View full text Add to dashboard Cite

show abstract

“…Mortality rates have decreased in the last decades, largely due to improvements in trauma systems and supportive critical care [29]. Yet, case fatality rates in severe TBI have not decreased significantly since 1990 [30], remaining with an outstanding mortality, because up to 50% of the patients will still die and nearly all survivors will present some degree of sequelae [3,4,6,[31][32][33]. To the present, regardless of over dozens of phase III clinical trials, there are no specific treatments known to improve TBI outcomes [13].…”

Section: Tbi Is Classified By Different Methods; In the 1970s Teasdamentioning

confidence: 99%

Traumatic Penumbra: Opportunities for Neuroprotective and Neurorestorative Processes

Regner¹,

Meirelles²,

Simon³

2018

Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management

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Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Understanding the pathophysiology of TBI is crucial for the development of more effective therapeutic strategies. At the moment of the traumatic impact, transfer of kinetic forces causes neurologic damage; this primary injury triggers a secondary wave of biochemical cascades, together with metabolic and cellular changes, called secondary neural injury. These areas of ongoing secondary injury, or areas of "traumatic penumbra," represent crucial targets for therapeutic interventions. This chapter is focused on the interplay between progression of parenchymal injury and the neuroprotective and neurorestorative processes that are emerging and developing subsequently to traumatic impact. Thus, we emphasized the role of traumatic penumbra in TBI pathogenesis and suggested a crucial contribution of the neurovascular units (NVUs) and paracrine effects of exosomes and miRNAs in promoting neurological recovery.

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“…Previous analyses of the same data showed no significant changes in benchmarking results when deaths were included in a competitive risks framework. 5 The research ethics board of the CHU de Québec approved our study.…”

Section: Patientsmentioning

confidence: 99%

“…[1][2][3] However, variations in patient outcomes have been observed even among level I trauma centres in the United States 4 and Canada, 5 and suboptimal quality of care has been documented in up to 50% of trauma system admissions. 6,7 Research has suggested that benchmarking activities stimulate quality improvement, which in turn improves patient outcomes.…”

mentioning

confidence: 99%

Canadian benchmarks for acute injury care

Moore

Evans

Yanchar

et al. 2017

CJS

Self Cite

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Background: Acute care injury outcomes vary substantially across Canadian provinces and trauma centres. Our aim was to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions.Methods: Benchmarks were derived using data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma centre in Canada and from the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, age 65 years or older. We assessed predictive validity using measures of discrimination and calibration, and performed sensitivity analyses to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally. Results:The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve 0.886, HosmerLemeshow 36). The LOS risk-adjustment model predicted 29% of the variation in LOS. Overall, observed:expected ratios of mortality and mean LOS generated by an analytically simple model correlated strongly with those generated by analytically complex models (r > 0.95, κ on outliers > 0.90). Conclusion:We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centres using Excel (see the appendices, available at canjsurg.ca). The program can be implemented using local trauma registries, providing that at least 100 patients are available for analysis.

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Mortality in Canadian Trauma Systems

Cited by 68 publications

References 21 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Traumatic Penumbra: Opportunities for Neuroprotective and Neurorestorative Processes

Canadian benchmarks for acute injury care

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