The advantages of early trauma team activation in the management of major trauma patients who underwent exploratory laparotomy

Yoo, Youngsun; Mun, Seong-Pyo

doi:10.4174/astr.2014.87.6.319

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…However, the time from arrival until CT scan was found to be shorter when TTA was done before the emergency department arrival of the patient. Past studies found that early TTA was associated with a decrease in the time to definitive care (Yoo & Mun, 2014) and that the trauma team arriving prior to the arrival of the patient allowed for better coordination of the team and the resources, decreasing the time to definitive care and a decreased length of stay in the emergency department (Polovitch et al, 2019). While the groups who had a TTA had shorter times noted on all time points when compared to those who did not have a TTA, the only timepoint that had a statistically significant improvement with pre-hospital TTA compared to a TTA after the arrival of the patient was the time from arrival to CT scan.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

English

Bourgeois,

Clark,

Delaney

et al. 2024

CJEN

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“…For patients treated with TTA care, our time to the CT scanner was 78 minutes, compared to 41-195 minutes for others who have assessed their trauma team indicators. [43][44][45] Our time in the emergency department with TTA was 2 hours 29 minutes, compared to 1.95 hours and 2 hours and 55 minutes from other studies. 4,46 In addition, when we compared patients who were treated by the trauma team to those who were not after our intervention, the former had much shorter time to the CT scanner, shorter treatment duration in acute care region of the emergency department and shorter overall time in the emergency department.…”

Section: Discussionmentioning

confidence: 99%

A quality-improvement approach to effective trauma team activation

Verhoeff

Saybel

Fawcett

et al. 2019

cjs

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Background: Appropriate, timely trauma team activation (TTA) can directly affect outcomes for patients with trauma. A review of quality-performance indicators at our Canadian level 1 trauma centre showed a high level of undertriage, with TTA compliance rates less than 60% for major trauma. A quality-improvement project was undertaken, targeting a sustained goal of at least 90% TTA compliance based on Accreditation Canada guidelines. Methods: Quality-improvement action followed a well-defined process. Baseline data collection was performed, and, in keeping with the Donabedian approach, we brought together stakeholders to collectively review and understand the reasons behind poor TTA compliance; and root-cause analysis. This was followed by rapid change cycles that focused on structure and processes with ongoing audits to support and sustain change. Results: Trauma team activation compliance improved from 58.8% to more than 90% over 2 years. Quality indicators showed a statistically significant reduction in the time to computed tomography scanner, time in the acute care region of the emergency department and total time in the emergency department, with improved TTA compliance. Conclusion: Compliance with TTA protocols improved to more than 90% over a 2-year period, which shows the benefit of having a clearly outlined qualityimprovement process. This well-defined quality-improvement method provides a framework for use by other institutions that seek to improve their processes of trauma care, including activation rates. Contexte : Le déploiement rapide et approprié de l'équipe de traumatologie (DÉT) peut avoir une influence directe sur les résultats chez les polytraumatisés. Une revue des indicateurs de qualité/performance dans notre centre de traumatologie canadien de niveau 1 a révélé une lacune importante au plan du triage, et des taux de conformité aux protocoles de DÉT atteignant moins de 60 % pour les traumatismes majeurs. Un projet d'amélioration de la qualité a donc été entrepris avec pour objectif une conformité soutenue d'au moins 90 % aux protocoles de DÉT selon les lignes directrices d'Agrément Canada. Méthodes : Les mesures d'amélioration de la qualité ont suivi un processus bien défini. Une collecte des données de référence a été effectuée, et conformément au modèle de Donabedian, nous avons réuni les différentes parties intéressées pour revoir et comprendre ensemble les raisons de la piètre conformité aux protocoles de DÉT et procéder à leur analyse en profondeur. On a ensuite appliqué des cycles de changements rapides axés sur la structure et les procédés, accompagnés de vérifications en continu pour les appuyer et les maintenir. Résultats : La conformité aux protocoles de déploiement de l'équipe de traumatologie s'est améliorée, passant de 58,8 % à plus de 90 % en l'espace de 2 ans. Les indicateurs de qualité ont montré des réductions statistiquement significatives du délai prétomographie, du temps passé dans la section de soins aigus du service des urgences et du temps total passé aux urgences, de m...

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“…In 2002, a multicenter cohort study conducted in the United States reported that the mortality rate for hypotensive trauma patients undergoing emergent laparotomies was approximately 40% [3]. In 2017, another multicenter cohort study from the United States reported the mortality rate of emergent laparotomies to be major trauma patients was 23.7% [7]. Ajou University Medical Center, Suwon, Korea currently acts as a regional trauma center, enabling the collection of patient data using the Korean Trauma Data Bank.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center

Yoo

Kang

2021

J Acute Care Surg

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Purpose: The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.Methods: Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.Results: There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality.Conclusion: Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

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The advantages of early trauma team activation in the management of major trauma patients who underwent exploratory laparotomy

Cited by 10 publications

References 19 publications

English

English

A quality-improvement approach to effective trauma team activation

Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center

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