Prehospital care is critical to improving outcomes after major trauma

Wandling, Michael W.; Cotton, Bryan A.

doi:10.1002/bjs.11589

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…Prompt, high-quality pre-hospital emergency medical services save lives. In the critical moments after trauma or medical emergencies, patients need timely and definitive care to optimize clinical outcomes [ 1 , 2 ]. In high-income countries, highly responsive trauma systems have cut mortality significantly [3] .…”

Section: Introductionmentioning

confidence: 99%

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Niyonsaba,

Nkeshimana,

Uwitonze

et al. 2023

African Journal of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Niyonsaba,

Nkeshimana,

Uwitonze

et al. 2023

African Journal of Emergency Medicine

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“…During the last decades, the improvement in diagnostic strategies and patient management has led to a remarkable decline in the mortality rate of patients with trauma injuries. Numerous studies have affirmed the improvement in trauma survival rates among patients from different regions [4][5][6][7]. However, it is important to note that keeping trauma patients with major injuries alive makes them susceptible to trauma-related complications [8].…”

Section: Introductionmentioning

confidence: 99%

Frequency of posttrauma complications during hospital admission and their association with Injury Severity Score

Dasdar,

Yousefifard,

Ranjbar

et al. 2023

Clin Exp Emerg Med

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Objective Multiple trauma is associated with a remarkable risk of in-hospital complications, which harm healthcare services and patients. This study aimed to assess the incidence of posttrauma complications, their relationship with poor outcomes, and the effect of the Injury Severity Score (ISS) on their occurrence.Methods This retrospective cohort study was conducted at a pair of trauma centers, between January 2020 and December 2022. All hospitalized adult patients with multiple trauma were included in this study. Multivariable logistic regression was used to identify factors related to posttrauma complications.Results Among 727 multiple trauma patients, 90 (12.4%) developed in-hospital complications. The most frequent complications were pneumonia (4.8%), atelectasis (3.7%), and superficial surgical site infection (2.5%). According to multivariable logistic regression, ISS, the length of stay in the intensive care unit (ICU), the length of stay in the hospital, and mortality were significantly associated with complications. The complication rate increased by 17% with every single-unit increase in ISS (adjusted odds ratio [OR], 1.17; 95% confidence interval [CI], 1.00–1.38). Per every 1-day increase in the ICU or hospital stay, the complication rate increased by 65% (adjusted OR, 1.65; 95% CI, 1.00–2.73) and 20% (adjusted OR, 1.20; 95% CI, 1.03–1.41), respectively. Posttrauma complications were also significantly more common in patients with mortality (adjusted OR, 163.30; 95% CI, 3.04–8,779.32). In multiple trauma patients with a higher ISS, the frequency, severity, and number of complications were significantly increased.Conclusion In-hospital complications in multiple trauma patients are frequent and associated with poor outcomes and mortality. ISS is an important factor associated with posttrauma complications.

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“…Trauma care is provided on a continuum from pre-hospital, the emergency department and other in-hospital services to post-hospital care, including rehabilitation (Lorthios-Guilledroit, 2020). When critically injured patients do not receive the appropriate care, death may occur within hours of injury, primarily from uncontrolled hemorrhage and brain injury (Wandling & Cotton, 2020). Appropriate resource utilization depends on accurate trauma triage in the pre-hospital and in-hospital settings.…”

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confidence: 99%

English

Bourgeois,

Clark,

Delaney

et al. 2024

CJEN

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Background: For patients sustaining major trauma, decreasing time to definitive care remains a primary goal. Specialized trauma team involvement is essential for coordinating the emergency department care of complex major trauma patients. The aim of this study was to evaluate if the timing of trauma team involvement impacts length of stay and time to definitive care in the emergency department. Methods: This is a single-centre retrospective medical record review, including patients meeting Quebec pre-hospital triage criteria for major trauma from May 15, 2018 to December 31, 2020. We assessed time from patient arrival until departure from the resuscitation room, time to CT scan, time to disposition, and overall length of emergency department stay. Patients were grouped according to the timing of trauma team activation (TTA) as (1) pre-hospital notification, (2) on arrival in the emergency department, (3) receiving a trauma consult only, or (4) no trauma team involvement. Mean times and standard deviations were calculated, and group differences were assessed using the Kruskal-Wallis test and the independent sample Mann-Whitney U test. Results: We identified 371 patients meeting our inclusion criteria; there were no differences between groups in mean time spent in the resuscitation room based on the timing of trauma team involvement (45-51 minutes, p=0.422). A trauma team activation with pre-hospital notification was associated with a statistically significant shorter time to CT scan (62-81 minutes, p=0.010), time to disposition (6:37-13:41, p<0.001), and total emergency department length of stay (9:22-23:16 hours: minutes, p<0.001). Conclusion: Appropriate trauma team activation improves performance indicators used to evaluate the quality of care in the emergency department. This research suggests that pre-hospital trauma team activation should be considered the standard of care for all patients meeting pre-hospital field triage criteria for major trauma. Keywords: trauma, triage, pre-hospital, trauma team activation, trauma quality indicators

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Prehospital care is critical to improving outcomes after major trauma

Cited by 5 publications

References 16 publications

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Frequency of posttrauma complications during hospital admission and their association with Injury Severity Score

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