Trauma case management: Improving patient outcomes (original) (raw)
Related papers
Complication Rates among Trauma Centers
Journal of the American College of Surgeons, 2009
Background-To examine the association between patient complications and admission to level 1 trauma centers (TC) compared to non-trauma centers (NTC). Study Design-A retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 level 1 TC and 51 NTC in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified as well as the presence or absence of 13 specific complications. Results-Patients treated in TC were more likely to have any complication compared to NTC with an adjusted relative risk (RR) of 1.34 (95% CI 1.03, 1.74). For individual complications, only urinary tract infection RR 1.94 (95% CI 1.07, 3.17) was significantly higher in TC. TC patients were more likely to have three or more complications, RR 1.83 (95% CI 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TC. Conclusions-Trauma centers have a slightly higher incidence rate of complications even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TCassociated complications. PA catheter use and intubation had the most influence on overall TC
Trauma admissions to the ICU of a tertiary hospital in a low resource setting
Aluta digest magazine, 2010
Background: Trauma remains a leading cause of morbidity and mortality in resource challenged economies. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually admitted into the intensive care unit in our hospital. The aim of this study is to assess the outcome of the trauma cases admitted to the ICU. Methods: We performed an eight-year retrospective review of all trauma admissions into our multidisciplinary six bed intensive care unit (ICU) to assess the impact of trauma on the ICU. Data collected was processed using the Statistical Packages for the Social Scientists 16.0. Results: Three hundred and seventy two cases (372) cases of major trauma were admitted during the study period, representing 41.6% of the total ICU admissions. The male to female ratio was 2.3:1, while the mean age of the trauma patients was 32.8 yrs compared to 37.0 yrs for non-trauma cases. Trauma admissions were almost exclusively emergencies (93.8%) with a mean ICU length of stay of 7.7 ± 8.1 days. Survivors had a statistically significant longer length of stay (LOS) than non-survivors (11.6 ± 9.8 vs. 4.2 ± 3.9 days [p = 0.0001]). Mortality rate of trauma patients was significantly higher than that of all ICU admissions (53.2% vs. 37.9%, p = 0.0001). Road traffic crashes were responsible for most deaths (68.6%) followed by burn injuries (29.9%). Conclusion: Trauma is a leading cause of intensive care utilization in our hospital,. Management strategy should include increased public enlightenment campaign, enforcement of safety rules and improved pre-and in-hospital care of trauma victims.
Evolution of trauma management at a tertiary care hospital: A cohort study
International Journal of Surgery, 2011
Objective: To analyze the characteristics of polytrauma patients and to assess the outcome of trauma care as this specialty has evolved over the years at a university hospital. Methods: The study included all polytrauma patients treated between January 1998 and September 2005 at a tertiary care hospital in a megacity. Data of 1009 patients was collected prospectively and analyzed retrospectively. Patients were divided into two groups A and B, based on their presentation before and after the introduction of a formal trauma training course in 2002. The analysis included demographic data, injury severity score, vital signs including hemodynamics and GCS on admission, intubation rates, mortality and complications. Results: 435 patients were included in group A (1998e2001) whereas group B (2002e2005) comprised of 574 patients. The proportion of patients with accidental versus intentional injuries was similar in both groups. The mean injury severity score of group A was 11.9 whereas that of group B was 11.7. Almost 50% of patients were transferred from other hospitals. Transferred patients had significantly lower GCS (p < 0.001), higher ISS (p < 0.001) and longer ICU stays (p < 0.001) in both (A and B) patient groups, while in group A mortality was also higher (p ¼ 0.018). A significantly higher number of patients in group B went into shock. The overall mortality rate was 9.7% for group A which significantly decreased to 5.7% for group B (p < 0.05). Conclusions: This study supports the view that as trauma care evolved at our hospital with the establishment of a formal training program, the mortality rates have significantly decreased.
Management of Trauma Patient in the Hospital Settings
Albanian Journal of Trauma and Emergency Surgery
Introduction: Trauma can be defined as a ‘blunt or penetrating external force exerted on the body resulting in injury’. Traumatic injury is a leading cause of death globally among persons under the age of 45 years. Over 5 million deaths occur each year as a result of injuries, representing 9% of the world's mortality. Non-fatal injuries are among the leading global cause of emergency department (ED) visits, hospitalizations, and long-term morbidity, accounting for a large part of health systems workload. Although road injuries, falls and self-harm are the top three causes of injury burden globally, their relative importance may differ according to the region. The initial assessment and management of traumatized patients should take place in a specialized area of an emergency department or a specialized trauma center. The time of injury is the essence of survival for life-threatening trauma. Appropriate initial care at the scene affects the morbidity and mortality of the traumati...
The Attributable Mortality and Length of Stay of Trauma-Related Complications
Annals of Surgery, 2010
Objective: To determine the attributable mortality (AM) and excess length of stay because of complications or complication groupings in the National Trauma Data Bank. Summary Background Data: Resources devoted to performance improvement activities should focus on complications that significantly impact mortality and length of stay. To determine which post-traumatic complications impact these outcomes, we conducted a matched cohort study. AM is the proportion of all deaths that can be prevented if the complication did not occur. Methods: We identified severely injured patients (Injury Severity Score, Ն9) at centers that contribute complications to the National Trauma Data Bank. To estimate the AM, a patient with a specific complication was matched to 5 patients without the complication. Matching was based on demographics and injury characteristics. Residual confounding was addressed through a logistic regression model. To estimate excess length of stay, matching covariates were identified through a Poisson regression model. Each case was required to match the control on all variables, and one control was selected per case. Results: Of the 94,795 patients who met the inclusion criteria, 3153 died. The overall mortality rate was 3.33%, and 10,478 (11.1%) patients developed at least 1 complication. Four complication groupings (cardiovascular, acute respiratory distress syndrome, renal failure, and sepsis) were associated with significant AM. Infectious complications (surgical infections, sepsis, and pneumonia) were associated with the greatest excess length of stay. Conclusions: This study used AM and excess length of stay to identify trauma-related complications for external benchmarking. Guideline development and performance improvement activities need to be focused on these complications to significantly reduce the probability of poor outcomes following injury.
North American Academic Research, 2024
Objective: To explore the effect of multidisciplinary team (MDT) in MIHS Provincial hospitals on severe trauma patients. Method: This study reviewed the treatment of patients with severe trauma in MIHS Provincial Hospital of Janakpurdham, Nepal from January 2023 to May 2024. The patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients. Result：From January 2023 to May 2024, 112 trauma patients were treated by MDT(Emergency Medicine, General Surgery and Orthopedics Departments) in MIHS Provincial Hospital Janakpurdham, Nepal. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 72.3±21.1 minutes for fast CT and 190.2±92.5 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital. Conclusion：The treatment of severe trauma patients by MDT (Emergency Medicine, General Surgery and Orthopedics Departments) in MIHS provincial hospitals can greatly improve the ability and level of treatment of severe trauma patients, improvement for the lack of treatment of severe trauma especially multiple trauma patients in hospitals and improve the treatment effect of severe trauma patients. It provides a reference model for large hospitals to treat patients with severe trauma and multiple trauma with collaborative approach.
Protocol for Urgent and Emergent Cases at a Large Academic Level 1 Trauma Center
Cureus
Background Level 1 trauma centers are capable of caring for every aspect of injury and contain 24-hour inhouse coverage by general surgeons, with prompt availability of nearly all other disciplines upon request. Despite the wide variety of trauma, currently reported protocols often focus on a single surgical service and studies describing their implementation are lacking. The aim of the current study was to characterize all urgent and emergent cases at a large academic Level 1 trauma center, characterize the specialty and nature of emergent operative cases, and assess the efficacy of the institutional trauma protocol on timing of surgery. Methods For this retrospective review, all urgent and emergent cases treated at a single institution, during a 34-month period (January 1, 2015-October 31, 2017), were identified. All included cases were subject to the Institutional Guidelines for Operative Urgent/Emergent Cases. Demographic characteristics for non-elective surgical emergent cases were compiled by level of urgency and operating room (OR) waiting times were compared by year, department, and Level. Results A total of 11,206 urgent and emergent operative cases were included, among over 16 surgical departments. Level 2 cases represented the majority of urgent/emergent cases (33%-36%), followed by Level 3 (25%-26%), Level 1 (21%-22%), Level 4 (12%-16%), and Level 5 (2%-4%). Univariate analysis demonstrated that the proportion of urgent and emergent cases, by level of urgency, did not significantly differ between each year. Operating room waiting time decreased
Journal of Trauma: Injury, Infection & Critical Care, 2011
Background: "Failure to rescue" patients with complications is a factor contributing to high mortality rates after elective surgery. In trauma, where early deaths are the primary contributors to a trauma center's mortality rate, the rescue of patients with complications might not be related to overall trauma center mortality. We assessed the extent to which trauma center mortality was reflected by the center's ability to rescue patients with major complications. Methods: Data were derived from the National Trauma Databank, and limited to adults with an Injury Severity Score Ն9 and to centers with adequate complication reporting. Regression models were used to produce center-level adjusted rates for mortality and complications. Centers were ranked on their adjusted mortality rate and divided into quintiles. Results: Of 76,048 patients, 9.6% had a major complication and 7.9% died. The mean complication rate in the quintile of centers with the highest mortality rates was 11.1%, compared with 7.7% in the quintile of centers with the lowest mortality rates (p ϭ 0.03). In addition, mortality among patients with complications differed significantly across quintiles. The mean mortality among patients with complications was 20.3% in the quintile of centers with the highest overall mortality rates, compared with 11.1% in the quintile of centers with the lowest overall mortality rates (p Ͻ 0.001). Conclusions: Unlike reports from elective surgery, complication rates after severe injury differ across centers and parallel mortality rates. Centers with low overall mortality are more successful at rescuing patients who experience complications. A lower risk of complications and better care of those with complications are both at play in high-performing trauma centers.
Analysis of Hospital Mortality and Epidemiology in Trauma Patients: A Multi-Center Study
Journal of Current Surgery, 2011
Background: This study evaluated the clinical characteristics of trauma patients in the southeastern coastal area of Turkey and investigated the factors influencing mortality. Methods: Patients admitted with trauma to the emergency departments of Harran and Gaziantep Medical Schools and to the emergency services of hospitals in Sanlıurfa between June 2008 and December 2008 were enrolled retrospectively in this study. All medical records and follow-up data were reviewed for each patient. Results: The study evaluated 15,120 trauma patients. The causes of trauma were motor vehicle accidents (38.7%), falls from heights (36.8%), burns (7.8%), knife wounds and gun shots (8.1%), homicides (6.5%), and workplace-related accidents (2.1%). The overall patient mortality rate was 3.8%. The mean patient ages were 47.8 ± 0.9 and 29.7 ± 0.4 among those who died and among those who survived, respectively (P < 0.01). The median times to arrival were 130 minutes and 42 minutes among those who died and among those who survived, respectively (P < 0.01). Whereas 79.9% of patients were discharged after treatment in the emergency departments, 16.3% were referred to various departments for hospitalization, and 3.8% were admitted to the intensive care unit (ICU). The mean score on the Glasgow Coma Scale was 7.5 ± 0.3 among who died and 12.8 ± 0.6 among those who survived (P < 0.05), and the mean Revised Trauma Scores were 8.7 ± 0.5 among those who died and 11.5 ± 0.7 among those who survived (P < 0.05). Intubation or cardiopulmonary resuscitation was initiated in 88% of those who died and 43.5% of those who survived (P < 0.05). Of those who died, 84% had cranial injuries and 43.5% had thoracic injuries. Conclusions: Frequent causes of trauma in our region are motor vehicle accidents and falls from heights. Type of trauma, rapid arrival at the hospital, hospital procedures and interventions, age, sex, and trauma scores were predictors of mortality in trauma patients.