Timely completion of multiple life-saving interventions for traumatic haemorrhagic shock: a retrospective cohort study

Abstract

Background Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury. Improved outcomes have been previously associated with single, timely interventions. The aim of this study was to assess the association between multiple timely life-saving interventions (LSIs) and outcomes of traumatic haemorrhagic shock patients. Methods A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency & Trauma Centre between July 01, 2010 and July 31, 2014. LSIs studied included chest decompression, control of external haemorrhage, pelvic binder application, transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention. The primary exposure variable was timely initiation of ≥ 50% of the indicated interventions. The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis. The association between total pre-hospital times and pre-hospital care times (time from ambulance at scene to trauma centre), in-hospital mortality and timely initiation of ≥ 50% of the indicated interventions were assessed. Results Of the 168 patients, 54 (32.1%) patients had ≥ 50% of indicated LSI completed within the specified time period. Timely delivery of LSI was independently associated with improved survival to hospital discharge (adjusted odds ratio (OR) for in-hospital death 0.17; 95% confidence interval (CI) 0.03–0.83; p = 0.028). This association was independent of patient age, pre-hospital care time, injury severity score, initial serum lactate levels and coagulopathy. Among patients with pre-hospital time of ≥ 2 h, 2 (3.6%) received timely LSIs. Pre-hospital care times of ≥ 2 h were associated with delayed LSIs and with in-hospital death (unadjusted OR 4.3; 95% CI 1.4–13.0). Conclusions Timely completion of LSI when indicated was completed in a small proportion of patients and reflects previous research demonstrating delayed processes and errors even in advanced trauma systems. Timely delivery of a high proportion of LSIs was associated with improved outcomes among patients presenting with haemorrhagic shock after injury. Provision of LSIs in the pre-hospital phase of trauma care has the potential to improve outcomes.

The direct medical cost of trauma aetiologies and injuries in a resource limited setting of Papua New Guinea: A prospective cost of illness study

“… 6 , 22 The increased injury severity score's and high operative rate of injuries indicates timely surgical intervention. 23 As a result, our complication and mortality rates are comparable to studies done in high volume trauma centres globally. 24 , 25 …”

Clinical Effect of Nursing Based on the Kano Model in Emergency Multiple Injuries

“…However, the routine care of multiple injuries in the emergency department is mainly based on characteristics of the common diseases, focusing on the care for patients with severe diseases, barring enough interest to the psychological nation and character desires. So, the nursing measures are not targeted and systematic, resulting in unfavorable results and low satisfaction [ 13 , 14 ]. In recent years, with the popularization of the Kano model, nursing intervention based on the Kano model has been widely used in clinical practice.…”

Multi‐disciplinary, simulation‐based, standardised trauma team training within the Victorian State Trauma System

“…Skill stations: Four skill stations were set up for the programme day: haemorrhage control and vascular access, tourniquet and pelvic binder application, pleural decompression and surgical airway. The sessions were based on the set of procedures considered to be essential life‐saving interventions in the setting of major trauma 18 . Debriefing was included in the skill stations.…”

“…The sessions were based on the set of procedures considered to be essential life‐saving interventions in the setting of major trauma. 18 Debriefing was included in the skill stations.…”