The effect of an on-site trauma surgeon during resuscitations of severely injured patients

Maarseveen, Oscar E. C. van; Ham, Wietske H. W.; Leenen, Loek P. H.

doi:10.1186/s12873-022-00724-3

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…There were no statistically signi cant differences in patient age, gender, injury severity, or EMS prehospital time between the study cohorts (Table 1). There was statistically signi cant improvement in the T-NOTECHS score after the implementation of the SD: 12 [10][11][12][13][14] out of possible 25 points or 48% [40-56%] in the before SD group and 16 [14][15][16][17][18][19] points or 64% [56-75%] in the after SD group (p < 0.001). Comparison of the distribution in ve behavior domains between the study groups are shown in Table 5.…”

Section: Resultsmentioning

confidence: 99%

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Impact of video recordings review with structured debriefings on trauma team performance: a prospective observational cohort study

Aukstakalnis,

Stucinskas,

Dobozinskas

et al. 2024

Eur J Trauma Emerg Surg

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BackgroundMany methods and tools have been suggested to enhance the e ciency of trauma team (TT) work. However, most of these methods necessitate costly simulators and mannequins, which demand signi cant nancial and human resources. ObjectiveWas to determine the impact of structured debrie ngs (SD) with audio/video review of trauma patients' resuscitation events on TT technical and non-technical skills. MethodsSingle center prospective observational cohort study. The study included all ED patients aged 18 years or older who received resuscitation from the trauma team (TT). Virtual meeting was held with the TT using SD to review one trauma patient resuscitation video. Technical skills improvement was based on adherence to the ATLS protocol and non-technical skills based on T-NOTECHS scale.

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Section: Resultsmentioning

confidence: 99%

“…Similarly, in a study by Scherer LA et al [18] it was reported that feedback with video tape review had a positive impact on breathing and circulation assessment as well as back examination [18]. Another study reported that having a trauma surgeon on site also increased the number of patients whose backs were examined [19].…”

Section: Discussionmentioning

confidence: 98%

Impact of video recordings review with structured debriefings on trauma team performance: a prospective observational cohort study

Aukstakalnis,

Stucinskas,

Dobozinskas

et al. 2024

Eur J Trauma Emerg Surg

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“…Underscoring the importance of our study is the relatively recent focus on trauma-specific process improvement measures undertaken at institutions across the globe. Other methods for improving efficiency in the trauma bay that have been studied include standardizing trauma bay organization, having a trauma surgeon on-site, and establishing time goals for time spent during resuscitation and to disposition (Philipose et al, 2022; Taylor et al, 2020; van Maarseveen et al, 2022). Additionally, criteria have been developed to determine which trauma patients are at increased risk of emergent surgery to expedite them to the OR, with studies showing an improvement in survival (Johnson et al, 2020; Martin et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Direct to Operating Room for Decompressive Craniotomy/Craniectomy in Patients With Traumatic Brain Injury

Kelley,

Jaje,

Smitterberg

et al. 2023

Journal of Trauma Nursing

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BACKGROUND: Emergent decompressive craniotomy/craniectomy can be a lifesaving surgical intervention for select patients with traumatic brain injury. Prompt management is critical as early decompression can impact traumatic brain injury outcomes. OBJECTIVE: This study aims to describe the feasibility and clinical impact of a new pathway for transporting patients with severe traumatic brain injury directly to the operating room from the trauma bay for decompressive craniotomy/craniectomy. METHODS: This is a retrospective cohort preintervention and postintervention study of severe traumatic brain injury patients undergoing decompressive craniectomy/craniotomy at a Midwestern U.S. Level I trauma center between 2016 and 2022. In the new pathway, the in-house trauma surgeon takes the patient directly to the operating room with the neurosurgery advanced practice provider to drape and prepare the patient for surgery while the neurosurgeon is en route to the hospital. RESULTS: A total of 44 patients were studied, five (5/44, 11.4%) of which were in the preintervention group and 39 (39/44, 88.6%) in the postintervention group. The median arrival-to-operating room time was shorter in the postintervention cohort (1.4 hr) than in the preintervention cohort (1.5 hr). In examining night shifts only, the preintervention cohort had shorter arrival-to-operating room times (1.2 hr) than the postintervention cohort (1.5 hr). CONCLUSION: The study demonstrated that the new pathway is feasible and expedites patient transport to the operating room while awaiting the arrival of the on-call neurosurgeon.

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“…Lubbert et al, found a median of 32.9 min [ 11 ]. Van Maarseveen et al found mean resuscitation times of 23.4 and 19.1 min for severely injured patients (ISS ≥ 16) resuscitated in a setting with an on-call versus in-house trauma surgeon, respectively [ 15 ]. These shorter resuscitation times compared to our findings might plausibly be caused by differences in the severity of the included patients, as our study’s population median ISS of 5.5 (8.3) was relatively low.…”

Section: Discussionmentioning

confidence: 99%

The effect of a clock’s presence on trauma resuscitation times in a Dutch level-1 trauma center: a pre–post cohort analysis

Berkeveld,

Azijli,

Bloemers

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Interventions performed within the first hour after trauma increase survival rates. Literature showed that measuring times can optimize the trauma resuscitation process as time awareness potentially reduces acute care time. This study examined the effect of a digital clock placement on trauma resuscitation times in an academic level-1 trauma center. Methods A prospective observational pre–post cohort analysis was conducted for six months before and after implementing a visible clock in the trauma resuscitation room, indicating the time passed since starting the in-hospital resuscitation process. Trauma patients (age ≥ 16) presented during weekdays between 9.00 AM and 9.00 PM were included. Time until diagnostics (X-Ray, FAST, or CT scan), time until therapeutic intervention, and total resuscitation time were measured manually with a stopwatch by a researcher in the trauma resuscitation room. Patient characteristics and information regarding trauma- and injury type were collected. Times before and after clock implementation were compared. Results In total, 100 patients were included, 50 patients in each cohort. The median total resuscitation time (including CT scan) was 40.3 min (IQR 23.3) in the cohort without a clock compared to 44.3 (IQR 26.1) minutes in the cohort with a clock. The mean time until the first diagnostic and until the CT scan was 8.3 min (SD 3.1) and 25.5 min (SD 7.1) without a clock compared to 8.6 min (SD 6.5) and 26.6 min (SD 11.5) with a clock. Severely injured patients (Injury Severity Score (ISS) ≥ 16) showed a median resuscitation time in the cohort without a clock (n = 9) of 54.6 min (IQR 50.5) compared to 46.0 min (IQR 21.6) in the cohort with a clock (n = 8). Conclusion This study found no significant reduction in trauma resuscitation time after clock placement. Nonetheless, the data represent a heterogeneous population, not excluding specific patient categories for whom literature has shown that a short time is essential, such as severely injured patients, might benefit from the presence of a trauma clock. Future research is recommended into resuscitation times of specific patient categories and practices to investigate time awareness.

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The effect of an on-site trauma surgeon during resuscitations of severely injured patients

Cited by 6 publications

References 19 publications

Impact of video recordings review with structured debriefings on trauma team performance: a prospective observational cohort study

Impact of video recordings review with structured debriefings on trauma team performance: a prospective observational cohort study

Direct to Operating Room for Decompressive Craniotomy/Craniectomy in Patients With Traumatic Brain Injury

The effect of a clock’s presence on trauma resuscitation times in a Dutch level-1 trauma center: a pre–post cohort analysis

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