Every minute counts: The impact of pre-hospital response time and scene time on mortality of penetrating trauma patients

2020 ◽  
Vol 220 (1) ◽  
pp. 240-244 ◽  
Author(s):  
Ahmed A.H. Nasser ◽  
Charlie Nederpelt ◽  
Majed El Hechi ◽  
April Mendoza ◽  
Noelle Saillant ◽  
...  
Keyword(s):  
Response Time ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
The Impact ◽  
Hospital Response

scholarly journals 45. The Impact of an Alert Tone on On-Scene Time in Trauma Patients

1996 ◽  
Vol 11 (S2) ◽  
pp. S42-S42
Author(s):  
Todd J. Le Duc ◽  
William E. Goellner ◽  
Nabil E. Sanadi
Keyword(s):  
Penetrating Trauma ◽  
Test Group ◽  
Control Group ◽  
Trauma Patients ◽  
Alert Message ◽  
The Impact ◽  
Versus Test

Objective: Determine whether radio alerts to paramedics after 7 minutes of on-scene time reduces total on-scene time for trauma patients.Methods: Paramedics radio base once they determine ACS criteria were met. Paramedics were informed by radio when 7 minutes lapsed on-scene. Dispatch times were recorded.Results: The control group (Nov. 1-30, 1995) of 135 consecutive patients were reviewed without a radio alert. The test group (Dec. 1-31, 1995) of 103 consecutive patients, with a radio alert message 7 minutes after scene arrival were also reviewed. Groups were matched for extrication times, blunt versus penetrating trauma, age, etc. We analyzed both groups for the interval of time from announcement of “trauma alert,” (when paramedics determined the patient met ACS criteria or from the time extrication was complete (if applicable) to the time en route to the hospital. Average on-scene time for the control group was 13.7 minutes [range 4-35] versus test group 9.3 minutes [range 2-26] (p <0.001).

scholarly journals The impact of ‘unofficial trauma’ on a Major Trauma Centre: A service evaluation of accident and emergency department trauma team activations

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 278-284
Author(s):  
Alex Wright ◽  
Simon J Mercer ◽  
Ben Morton
Keyword(s):  
Road Traffic ◽  
Statistical Tests ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Shop Floor ◽  
Trauma Patients ◽  
Healthcare Provision ◽  
Major Trauma Centre ◽  
The Impact

Introduction Trauma remains a leading cause of death worldwide. In the UK, data for trauma patients are prospectively collected locally and collated by the Trauma Audit and Research Network. This study assesses and describes the subgroup of patients who triggered a trauma call but who subsequently did not meet criteria for Trauma Audit and Research Network. Methods A single centre, retrospective observational study of trauma calls between 1 June 2012 and 31 August 2018 was performed, determining which trauma calls had been submitted to Trauma Audit and Research Network by cross referencing with the submission database. Data were tested for normality (Shapiro–Wilk test) and appropriate statistical tests employed to determine differences between inclusion and non-inclusion groups. For categorical data, we used Chi-squared tests to examine for differences. Results There were 6529 trauma calls and over half (3837 (58.8%)) were not registered on Trauma Audit and Research Network. Patients excluded were significantly younger (mean 42.4 years SD 19.2) than those who met inclusion criteria (mean 50.3 years, SD 21.8), p < 0.001 and were significantly more likely to suffer from penetrating trauma (18.6% versus 8.2%, p < 0.001), the majority (77.8%, 553/713) caused by stabbings. Patients excluded were less likely to be involved in a road traffic accident (31.1% versus 35.3%, p < 0.001), less likely to have fallen downstairs (15.2% versus 18.7%, p < 0.001) and less likely to have fallen from a height > 2 m (8.1% versus 12.7%, p < 0.001). Discussion Patients who trigger a trauma call but who subsequently do not meet the criteria for Trauma Audit and Research Network inclusion place a significant burden on healthcare provision. To our knowledge this is the first investigation to specifically explore this group of at-risk patients. To enable medical planners a more accurate view of activity on the ‘shop floor’, particularly in reference to knife crime injuries we ask the question as to whether a separate database should now be held of trauma calls?

Analysis of pre-hospital rescue times on mortality in trauma patients in a Scandinavian urban setting

Trauma ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 28-34 ◽  
Author(s):  
A Bagher ◽  
L Todorova ◽  
L Andersson ◽  
CJ Wingren ◽  
A Ottosson ◽  
...  
Keyword(s):  
Response Time ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Multivariate Regression Analysis ◽  
Urban Setting ◽  
Blunt Injury ◽  
Trauma Patients ◽  
New Injury Severity Score ◽  
Transport Distance ◽  
Centre Hospital

Objective To analyze if pre-hospital rescue times were associated with mortality in a trauma cohort arriving by ambulance to hospital in a Scandinavian urban setting. Methods Between 2011 and 2013, individuals and pre-hospital rescue times were identified in Emergency Medical Dispatcher Centre, hospital, and forensic records in red alarm trauma. Major trauma was defined as a New Injury Severity Score (NISS)>15. Results Overall, 89% of 378 trauma patients received hospital care within 60 min; 51% had a response time of ≤8 min, and 95% had response time within ≤20 min. The on-scene time (p < 0.05) and total pre-hospital time (p < 0.05) were longer for patients ≥65 years, in comparison with patients <65 years. The patients with penetrating trauma had shorter on-scene time (p < 0.01), total pre-hospital time (p < 0.01), and shorter transport distance from trauma scene to hospital (p = 0.004), compared to those with blunt trauma. Patients with NISS > 15 were found to have the same pre-hospital rescue times as those with NISS ≤ 15. There was a trend that the occurrence of gunshots was associated with increased mortality (p = 0.074). When entering age, NISS, penetrating versus blunt injury, response time, and on-scene time in a multivariate regression analysis, age (p < 0.001), NISS (p < 0.001), and penetrating injury (p = 0.009) remained as independent factors associated with mortality and a trend for shorter on-scene time (p = 0.093). Conclusions Pre-hospital rescue times had less impact on mortality than injury severity, age, and penetrating trauma. Even though penetrating traumas were associated with shorter on-scene time and shorter transport distance to hospital, mortality was increased in this Scandinavian urban setting.

scholarly journals Infection Complications After Trauma Contribute to Increased in-Hospital Mortality in Mild Patients Compared With Severe Patients: A Retrospective Cohort Study Using a Nationwide Trauma Registry in Japan

2021 ◽  
Author(s):  
Akira Komori ◽  
Hiroki Iriyama ◽  
Takako Kainoh ◽  
Makoto Aoki ◽  
Toshio Naito ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Trauma Severity ◽  
The Impact

Abstract Background: Infection is a very common but poor prognostic complication affecting trauma patients. However, the impact of infection on the prognosis of trauma patients according to severity remains unclear. We aimed to assess the impact of infection complications on in-hospital mortality among patients with trauma according to severity. Methods: This retrospective cohort study used a nationwide registry of trauma patients (Japan Trauma Data Bank). Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15–29), or severe (ISS ≥ 30). Results: Among the 150,948 patients in this study, 10,172 (6.7%) developed infections. The severity of trauma was greater in patients with infection than those without [mild, 3,837 (37.7%) vs. 84,106 (59.7%); moderate, 4,518 (44.4%) vs. 47,809 (34.0%); severe, 1,817 (17.9%) vs. 8,861 (6.3%), p < 0.01]. Patients with infection had greater in-hospital mortality than patients without infection [1,079 (10.6%) vs. 2,904 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed significantly between trauma patients with and without infection according to trauma severity [16.7% (95% CI; 14.6%–18.8%) vs. 3.6% (95% CI; 3.3%–3.9%), p < 0.01, in patients with mild trauma; 12.3% (95% CI; 11.0%–13.6%) vs. 7.3% (95% CI; 6.9%–7.7%), p < 0.01, in patients with moderate trauma; and 12.0% (95% CI; 9.8%–14.2%) vs. 11.1% (95% CI; 9.8%–12.4%), p = 0.41, in patients with severe trauma].Conclusion: The effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

scholarly journals The impact of infection complications after trauma differs according to trauma severity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akira Komori ◽  
Hiroki Iriyama ◽  
Takako Kainoh ◽  
Makoto Aoki ◽  
Toshio Naito ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Severe Trauma ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Trauma Severity ◽  
Baseline Characteristics ◽  
General Wards ◽  
The Impact

AbstractThe impact of infection on the prognosis of trauma patients according to severity remains unclear. We assessed the impact of infection complications on in-hospital mortality among patients with trauma according to severity. This retrospective cohort study used a nationwide registry of trauma patients. Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15–29), or severe (ISS ≥ 30). Among the 150,948 patients in this study, 10,338 (6.8%) developed infections. Patients with infection had greater in-hospital mortality than patients without infection [1085 (10.5%) vs. 2898 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed between trauma patients with and without infection according to trauma severity [17.1% (95% CI 15.2–18.9%) vs. 2.9% (95% CI 2.7–3.1%), p < 0.01, in patients with mild trauma; 14.8% (95% CI 13.3–16.3%) vs. 8.4% (95% CI 7.9–8.8%), p < 0.01, in patients with moderate trauma; and 13.5% (95% CI 11.2–15.7%) vs. 13.7% (95% CI 12.4–14.9%), p = 0.86, in patients with severe trauma]. In conclusion, the effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

scholarly journals Networking for Cloud Robotics: The DewROS Platform and Its Application

2021 ◽  
Vol 10 (2) ◽  
pp. 34
Author(s):  
Alessio Botta ◽  
Jonathan Cacace ◽  
Riccardo De Vivo ◽  
Bruno Siciliano ◽  
Giorgio Ventre
Keyword(s):  
Response Time ◽  
Large Data ◽  
Cloud Services ◽  
Cloud Provider ◽  
Human Beings ◽  
Minimal Impact ◽  
Network Connection ◽  
Cloud Robotics ◽  
Networking Technologies ◽  
The Impact

With the advances in networking technologies, robots can use the almost unlimited resources of large data centers, overcoming the severe limitations imposed by onboard resources: this is the vision of Cloud Robotics. In this context, we present DewROS, a framework based on the Robot Operating System (ROS) which embodies the three-layer, Dew-Robotics architecture, where computation and storage can be distributed among the robot, the network devices close to it, and the Cloud. After presenting the design and implementation of DewROS, we show its application in a real use-case called SHERPA, which foresees a mixed ground and aerial robotic platform for search and rescue in an alpine environment. We used DewROS to analyze the video acquired by the drones in the Cloud and quickly spot signs of human beings in danger. We perform a wide experimental evaluation using different network technologies and Cloud services from Google and Amazon. We evaluated the impact of several variables on the performance of the system. Our results show that, for example, the video length has a minimal impact on the response time with respect to the video size. In addition, we show that the response time depends on the Round Trip Time (RTT) of the network connection when the video is already loaded into the Cloud provider side. Finally, we present a model of the annotation time that considers the RTT of the connection used to reach the Cloud, discussing results and insights into how to improve current Cloud Robotics applications.

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

Sign in / Sign up

Export Citation Format

Share Document