Changing from a two-tiered to a one-tiered trauma team activation protocol: a before–after observational cohort study investigating the clinical impact of undertriage

Abstract Background The aim of this study was to compare the effect of the change in TTA protocol from a two-tier to one-tier, with focus on undertriage and mortality. Material and methods A before–after observational cohort study based on data extracted from the Stavanger University Hospital Trauma registry in the transition period from two-tier to a one-tier TTA protocol over two consecutive 1-year periods (2017–2018). Comparative analysis was done between the two time-periods for descriptive characteristics and outcomes. The main outcomes of interest were undertriage and mortality. Results During the study period 1234 patients were included in the registry, of which 721 (58%) were in the two-tier and 513 (42%) in the one-tier group. About one in five patients (224/1234) were severely injured (ISS > 15). Median age was 39 in the two-tier period and 43 years in the one-tier period (p = 0.229). Median ISS was 5 for the two-tier period vs 9, in the one-tier period (p = 0.001). The undertriage of severely injured patients in the two-tier period was 18/122 (15%), compared to 31/102 (30%) of patients in the one-tier period (OR = 2.5; 95% CI 1.8–4.52). Overall mortality increased significantly between the two TTA protocols, from 2.5 to 4.7% (p = 0.033), OR 0.51 (0.28–0.96) Conclusion A protocol change from two-tiered TTA to one-tiered TTA increased the undertriage in our trauma system. A two-tiered TTA may be beneficial for better patient care.

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Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study

World Journal of Emergency Surgery ◽

10.1186/1749-7922-8-36 ◽

2013 ◽

Vol 8 (1) ◽

Cited By ~ 9

Author(s):

Jacqueline JEM van Laarhoven ◽

Steven Ferree ◽

R Marijn Houwert ◽

Falco Hietbrink ◽

Egbert Jan MM Verleisdonk ◽

...

Keyword(s):

Cohort Study ◽

Clavicle Fracture ◽

Observational Cohort Study ◽

Injury Pattern ◽

Severely Injured ◽

Severely Injured Patients ◽

Observational Cohort ◽

Injured Patients ◽

Retrospective Observational Cohort Study

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Supervised machine learning-based prediction for in-hospital pressure injury development using electronic health records: A retrospective observational cohort study in a university hospital in Japan

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2021.103932 ◽

2021 ◽

pp. 103932

Author(s):

Gojiro Nakagami ◽

Shinichiroh Yokota ◽

Aya Kitamura ◽

Toshiaki Takahashi ◽

Kojiro Morita ◽

...

Keyword(s):

Machine Learning ◽

Cohort Study ◽

Electronic Health Records ◽

Observational Cohort Study ◽

University Hospital ◽

Supervised Machine Learning ◽

Health Records ◽

Pressure Injury ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

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Preliminary Evaluation of a Web-Based Psychological Screening Tool in Adolescents Undergoing Minimally Invasive Pectus Surgery: Single-Center Observational Cohort Study

JMIR Mental Health ◽

10.2196/mental.9806 ◽

2018 ◽

Vol 5 (2) ◽

pp. e45 ◽

Cited By ~ 1

Author(s):

Davina Wildemeersch ◽

Lisa Bernaerts ◽

Michiel D’Hondt ◽

Guy Hans

Keyword(s):

Cohort Study ◽

Self Esteem ◽

Observational Cohort Study ◽

Self Report ◽

University Hospital ◽

Anxiety And Depression ◽

Single Center ◽

Web Based ◽

Anxiety Trait ◽

Observational Cohort

Background Preoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health support and enhanced recovery after surgery. Objective This study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform. Methods Patients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of the International Council for Harmonisation–Good Clinical Practice guidelines and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). An online preoperative psychological inventory was performed using the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and State-Trait Anxiety Inventory. Postoperatively, pain intensity and interference were assessed using the Multidisciplinary Pain Inventory, Coping With Pain Questionnaire, and numeric pain rating scale assessment. Patient satisfaction of the Web-based platform was evaluated. Results A total of 21 adolescent patients used our Web-based psychological perioperative screening platform. Patients rated the mobile phone app, usability, and accessibility of the digital platform as good or excellent in 85% (17/20), 89% (17/19), and 95% (20/21) of the cases, respectively. A total of 89% (17/19) of the patients rated the effort of generating answers to the online questionnaires as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R=–0.72, P<.001) and overall anxiety characteristics (R=–0.49, P=.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R=0.52, P=.03 and R=0.6, P=.02, respectively) measured by the online self-report questionnaires. Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R=0.58, P=.02). Finally, there was a negative correlation between self-esteem and pain interference (R=–0.62, P=.01). Trial Registration ClinicalTrials.gov NCT03100669; https://clinicaltrials.gov/ct2/show/NCT03100669 (Archived by WebCite at http://www.webcitation.org/6zPvHDhU5)

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A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/240702 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Maria Grazia Porpora ◽

Roberto Brunelli ◽

Graziella Costa ◽

Ludovica Imperiale ◽

Ewa K. Krasnowska ◽

...

Keyword(s):

Cohort Study ◽

Side Effects ◽

Observational Cohort Study ◽

University Hospital ◽

Ovarian Endometriosis ◽

Virtual Absence ◽

Medical Needs ◽

Ovarian Endometrioma ◽

Observational Cohort ◽

Italian Women

Urged by the unmet medical needs in endometriosis treatment, often with undesirable side effects, and encouraged by N-acetylcysteine (NAC) efficacy in an animal model of endometriosis and by the virtual absence of toxicity of this natural compound, we performed an observational cohort study on ovarian endometriosis. NAC treatment or no treatment was offered to 92 consecutive Italian women referred to our university hospital with ultrasound confirmed diagnosis of ovarian endometriosis and scheduled to undergo laparoscopy 3 months later. According to patients acceptance or refusal, NAC-treated and untreated groups finally comprised 73 and 72 endometriomas, respectively. After 3 months, within NAC-treated patients cyst mean diameter was slightly reduced (-1.5 mm) versus a significant increase (+6.6 mm) in untreated patients (P=0.001). Particularly, during NAC treatment, more cysts reduced and fewer cysts increased their size. Our results are better than those reported after hormonal treatments. Twenty-four NAC-treated patients—versus 1 within controls—cancelled scheduled laparoscopy due to cysts decrease/disappearance and/or relevant pain reduction (21 cases) or pregnancy (1 case). Eight pregnancies occurred in NAC-treated patients and 6 in untreated patients. We can conclude that NAC actually represents a simple effective treatment for endometriosis, without side effects, and a suitable approach for women desiring a pregnancy.

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Severe Sepsis in the Emergency Department – An Observational Cohort Study from the University Hospital of the West Indies

West Indian Medical Journal ◽

10.7727/wimj.2012.194 ◽

2018 ◽

Cited By ~ 1

Author(s):

R Edwards ◽

R Hutson ◽

J Johnson ◽

R Sherwin ◽

G Gordon-Strachan ◽

...

Keyword(s):

Emergency Department ◽

Severe Sepsis ◽

Cohort Study ◽

West Indies ◽

Observational Cohort Study ◽

University Hospital ◽

The West ◽

Observational Cohort ◽

The University

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The Acute Impact of the COVID-19 Pandemic on Patients Presenting with Orthopaedic Injuries Across a Canadian Academic, Orthopaedic Trauma System: A Multi-Centre, Pre-Post Observational Cohort Study

OrthoMedia ◽

10.1302/3114-220775 ◽

2022 ◽

Keyword(s):

Cohort Study ◽

Trauma System ◽

Observational Cohort Study ◽

Orthopaedic Trauma ◽

System A ◽

Observational Cohort ◽

Orthopaedic Injuries

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Clinical and socio-demographic characteristics associated with involuntary admissions in Switzerland between 2008 and 2016: An observational cohort study before and after implementation of the new legislation

European Psychiatry ◽

10.1016/j.eurpsy.2019.04.004 ◽

2019 ◽

Vol 59 ◽

pp. 70-76 ◽

Cited By ~ 2

Author(s):

Florian Hotzy ◽

Michael P. Hengartner ◽

Paul Hoff ◽

Matthias Jaeger ◽

Anastasia Theodoridou

Keyword(s):

Cohort Study ◽

Psychiatric Treatment ◽

Routine Data ◽

Demographic Characteristics ◽

Observational Cohort Study ◽

University Hospital ◽

Organizational Level ◽

Increased Risk ◽

Before And After ◽

Observational Cohort

AbstractBackground:Involuntary admission (IA) for psychiatric treatment has a history of controversial discussions. We aimed to describe characteristics of a cohort of involuntarily compared to voluntarily admitted patients regarding clinical and socio-demographic characteristics before and after implementation of the new legislation.Methods:In this observational cohort study, routine data of 15’125 patients who were admitted to the University Hospital of Psychiatry Zurich between 2008 and 2016 were analyzed using a series of generalized estimating equations.Results:At least one IA occurred in 4’560 patients (30.1%). Of the 31’508 admissions 8’843 (28.1%) were involuntary. In the final multivariable model, being a tourist (OR = 3.5) or an asylum seeker (OR = 2.3), having a schizophrenic disorder (OR = 2.1), or a bipolar disorder (OR = 1.8) contributed most to our model. Male gender, higher age, prescription of neuroleptics (all OR < 2.0) as well as having a depressive disorder, prescription of psychotherapy, prescription of antidepressants and admission after implementation of the new legislation (all OR > 0.6) were also weakly associated with IA.Conclusions:Besides schizophrenic or bipolar disorders, a small group of patients had an increased risk for IA due to non-clinical parameters (i.e. tourists and asylum seekers). Knowledge about risk factors should be used for the development of multi-level strategies to prevent frequent (involuntary) hospitalizations in patients at risk. On the organizational level, we could show that the new legislation decreased the risk for IA, and therefore may have succeeded in strengthening patient autonomy.

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