Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

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Ten-Year Trends of Adult Trauma Patients in Denmark from 2010 to 2019: A Retrospective Cohort Study

10.21203/rs.3.rs-871619/v1 ◽

2021 ◽

Author(s):

Frederik Trier ◽

Jesper Fjølner ◽

Nikolaj Raaber ◽

Anders Høyer Sørensen ◽

Rasmus Søndergaard ◽

...

Keyword(s):

Incidence Rate ◽

Trauma Center ◽

Injury Severity ◽

Incidence Rate Ratio ◽

Trauma Patients ◽

Severe Injuries ◽

Annual Percent Change ◽

Fall Injuries ◽

Percent Change ◽

Minor Injuries

Abstract Background: Trauma causes a considerable economic and societal burden and the trauma patient population and its prognosis changes over time. The aim of this study is to analyze ten-year trends of trauma patients at a major trauma center in Denmark. Methods: 5366 patients aged ≥ 16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at Aarhus University Hospital Trauma Center between January 1, 2010 and December 31, 2019 were included. Descriptive statistics, incidence rate calculation, parametric and non-parametric test were used. An annual percent change with 95% confidence interval was used to estimate trend in mechanism of injuries. Multiple logistic regression with mortality as outcome were adjusted for age, sex and ISS. Results: The median age increased from 37 in 2010 to 49 in 2019 and the proportion of patients aged ≥ 65 doubled. The incidence of minor injuries (ISS 1-15) decreased from 181.3/105 inhabitants in 2010 to 112.7/105 in 2019 corresponding to an incidence rate ratio between 2019 and 2010 of 0.62 (95% CI: 0.54 to 0.72). Severe injuries (ISS > 15) increased from 10.1/105 inhabitants in 2010 to 13.6/105 in 2019 corresponding to an incidence rate ratio between 2019 and 2010 of 1.35 (95% CI: 1.04 to 1.76). The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression showed lower 30-day mortality for all trauma patients with ISS > 0 over the study period when adjusting for age, sex and ISS (Odds ratio: 0.94, 95% CI: 0.90 to 0.99). The 30-day mortality for severely injured patients with ISS > 15 decreased during the study period when adjusting for age, sex and ISS (Odds ratio: 0.92, 95% CI: 0.87 to 0.97). Fall injuries increased with an annual percent change of 4.1% (95% CI: 2.3% to 6.1%). Conclusions: Ten-year trends of trauma patients in Central Denmark Region show an increasing median age, injury severity and number of fall injuries. The 30-day mortality of trauma patients decreased for both minor injuries and severe injuries when adjusting for age, sex and injury severity. Trial registration: Not applicable.

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Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response

The American Surgeon ◽

10.1177/0003134820988827 ◽

2021 ◽

pp. 000313482098882

Author(s):

Adel Elkbuli ◽

Brianna Dowd ◽

Carol Sanchez ◽

Saamia Shaikh ◽

Mason Sutherland ◽

...

Keyword(s):

Emergency Medical Service ◽

Trauma Center ◽

Medical Service ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Transport Time ◽

Emergency Medical ◽

Level 1 ◽

Level 1 Trauma Center

Background The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. Methods A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. Results Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS ( P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS ( P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes ( P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). Conclusions Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.

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(A215) Delayed Diagnosis of Injury in Survivors of the February 2009 Crash of Flight TK 1951

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002056 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s59-s60

Author(s):

I.L.E. Postma ◽

J. Winkelhagen ◽

T. Bijlsma ◽

F. Bloemers ◽

M. Heetveld ◽

...

Keyword(s):

Injury Severity ◽

Life Support ◽

Delayed Diagnosis ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Emergency Intervention ◽

Plane Crash ◽

Tertiary Survey ◽

Clinically Significant ◽

The Uk

IntroductionIn 2009, a Boeing 737 crashed near Amsterdam, traumatically injuring 126 people. In trauma patients, some injuries initially escape detection. The aim of this study is to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the effects of tertiary survey on the victims of a plane crash.MethodsData collected included documentations of DDI, tertiary surveys, Injury Severity Scale (ISS) score, Glasgow Coma Scale score, number and type of injuries, and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. Comparison was made to a crash in the UK (1989), before advanced trauma life support became practiced widely.ResultsAll 126 victims were evaluated in a hospital emergency department; 66 were admitted with a total of 171 clinically significant injuries. Twelve clinically significant DDIs were found in eight patients (12%). In 65%, a tertiary survey was documented. The DDI incidences differed for several risk factors. Eighty-one survivors of the UK crash had a total of 332 injuries. Of those with > 5 injuries, 5% had a DDI, versus 8% of those with ≤ 5 injuries.ConclusionsThe DDI incidence in this study was 7% of the injuries in 12% of the population. A tertiary survey was documented in 65%; ideally this should be 100%. In this study, a high ISS score, head injury, > 5 injuries, and emergency intervention were associated with DDI. The DDI incidence in the current study was lower than in the UK crash.

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Early experience of a regional trauma center in Gangwon province: First step toward organizing a regional trauma system

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919831157 ◽

2019 ◽

Vol 27 (4) ◽

pp. 202-210

Author(s):

Kwangmin Kim ◽

Hongjin Shim ◽

Pil Young Jung ◽

Seongyup Kim ◽

Hui-Jae Bang ◽

...

Keyword(s):

Hospital Mortality ◽

Injury Severity Score ◽

Severity Score ◽

Trauma Center ◽

Injury Severity ◽

Trauma System ◽

Mortality Rates ◽

Trauma Patients ◽

Before And After ◽

The Impact

Background: The Korean Ministry of Health and Welfare decided to establish a trauma medical service system to reduce preventable deaths. OO hospital in Gangwon Province was selected as a regional trauma center and was inaugurated in 2015. Objectives: This study examines the impact of this center, comparing mortality and other variables before and after inaugurating the center. Methods: Severely injured patients (injury severity score > 15) presenting to OO hospital between January 2014 and December 2016 were enrolled and categorized into two groups: before trauma center (n = 365) and after trauma center (n = 904). Patient characteristics, variables, and patient outcomes (including mortality rate) before and after the establishment of trauma centers were compared accordingly for both groups. Risk factors for in-hospital mortality were also identified. Results: Probability of survival using trauma and injury severity score (%) method was significantly lower in the after trauma center group (81.3 ± 26.1) than in the before trauma center group (84.7 ± 21.0) (p = 0.014). In-hospital mortality rates were similar in both groups (before vs after trauma center group: 13.2% vs 14.2%; p = 0.638). The Z and W statistics revealed higher scores in the after trauma center group than in the before trauma center group (Z statistic, 4.69 vs 1.37; W statistic, 4.52 vs 2.10); 2.42 more patients (per 100 patients) survived after trauma center establishment. Conclusion: Although the mortality rates of trauma patients remained unchanged after the trauma center establishment, the Z and W statistics revealed improvements in the quality of care.

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Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000389 ◽

2018 ◽

Vol 33 (3) ◽

pp. 250-255 ◽

Cited By ~ 2

Author(s):

Mark Levitan ◽

Madelyn P. Law ◽

Richard Ferron ◽

Karen Lutz-Graul

Keyword(s):

Complex Adaptive Systems ◽

Adaptive Systems ◽

Emergency Services ◽

Life Support ◽

Systems Approach ◽

Prehospital Care ◽

Trauma Patients ◽

Publication Type ◽

Complex Adaptive ◽

Facilitators And Barriers

AbstractIntroductionAccording to Ontario, Canada’s Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features.ProblemResearch addressed the following problem: what are the facilitators and barriers to achieving 10-minute OSTs?MethodsThis project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data.ResultsThirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics’ ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment.ConclusionThese findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard.LevitanM,LawMP,FerronR,Lutz-GraulK.Paramedics’ perspectives on factors impacting on-scene times for trauma calls.Prehosp Disaster Med.2018;33(3):250–255.

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The Effect of Prehospital Transport Time on the Mortality from Traumatic Injury

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041625 ◽

1995 ◽

Vol 10 (1) ◽

pp. 24-29 ◽

Cited By ~ 58

Author(s):

Roland W. Petri ◽

Alan Dyer ◽

John Lumpkin

Keyword(s):

Analysis Of Variance ◽

Trauma Center ◽

Injury Severity ◽

Traumatic Injury ◽

Trauma Patients ◽

Transport Time ◽

Patient Transport ◽

Severity Of Injury ◽

Level I ◽

Prehospital Time

AbstractObjective:To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital.Design:Review of data contained within the Illinois Trauma Registry encompassing the period from fall 1989 through spring 1991.Participants:A total of 5,215 injured persons with an Injury Severity Score (ISS) >10, cared for in an Illinois level-I or -II trauma center outside of the city of Chicago.Measurements:Injury severity expressed as ISS, scene time (ST), transport time (TrT), total emergency medical services time (TEMST), and outcome were determined for each patient. Patients were stratified into groups on the basis of ISS.Results:Patient outcomes were significantly different statistically between ISS groups (p <0.001, X2). Mean ST and TEMST, but not TrT, were significantly different statistically between ISS groups (p <0.001, analysis of variance). Lower ISS was associated with longer times. Mean ST, TrT, and TEMST were significantly different statistically between survivors and nonsurvivors (p <0.001, two-sample t-tests). Survival was associated with longer times. Each of the mean times remained significantly different between survivors and nonsurvivors after controlling for severity of injury (p <0.001, two-way analysis of variance).Conclusion:No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time <90 minutes exerted a significant adverse effect upon survival.

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Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽

10.24908/pocus.v1i3.13263 ◽

2016 ◽

Vol 1 (3) ◽

pp. 13-14

Author(s):

Stuart Douglas, PGY4 ◽

Joseph Newbigging, MD ◽

David Robertson, MD

Keyword(s):

Case Report ◽

Negative Predictive Value ◽

Predictive Value ◽

Life Support ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Ultrasound Probe ◽

Trauma Resuscitation ◽

Highly Sensitive ◽

Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

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Independent Predictors of Mortality in Torso Trauma Injuries

Journal of Clinical Medicine ◽

10.3390/jcm9103202 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3202

Author(s):

Roberto Bini ◽

Caterina Accardo ◽

Stefano Granieri ◽

Fabrizio Sammartano ◽

Stefania Cimbanassi ◽

...

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Demographic Data ◽

Trauma Patients ◽

Related Condition ◽

Predictors Of Mortality ◽

Risk Of Death ◽

Therapeutic Procedures ◽

Torso Trauma ◽

Enhanced Computed Tomography

Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

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Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000672 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000672

Author(s):

Ryan Pratt ◽

Mete Erdogan ◽

Robert Green ◽

David Clark ◽

Amanda Vinson ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Nova Scotia ◽

Kidney Disease ◽

Hospital Mortality ◽

Major Trauma ◽

Injury Severity ◽

Cox Regression ◽

Trauma Patients ◽

Risk Of Death ◽

Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

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Abstract TP245: Variance in Ems Run Times by Receiving Hospital for Stroke Patients in San Diego County

Stroke ◽

10.1161/str.51.suppl_1.tp245 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amelia Kenner-brininger ◽

Lindsay Olson-Mack ◽

Lorraine Calzone ◽

Kristi L Koenig ◽

Thomas M Hemmen

Keyword(s):

Response Time ◽

San Diego ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

San Diego County ◽

Stroke Patients ◽

Transport Time ◽

Stroke Registry ◽

Few Data

Background: Emergency Medical Services (EMS) play an important role as initial providers after stroke. Few data are available that capture Stroke Receiving System and EMS response and transport data. We used a stroke registry from a community of 3.3 million residents, 18 stroke receiving centers, and 19 ground transporting advanced life support EMS agencies to evaluate EMS response time, scene time, and transport times. Our aim was to inform the stroke community about duration of EMS care and guide future prehospital interventions. Methods: We included all cases from the San Diego County Stroke Registry arriving by EMS with associated computer automated dispatch (CAD) record and base hospital record (BHR) from July 2017 through December 2018. Records were linked on the EMS incident number, reviewed for accuracy. We analyzed EMS response, scene, transport and total run times (enroute to arrival) by receiving hospital. Results: Between July 2017 and December 2018 2,376 EMS patients were transported to 18 hospitals. Volume per hospital ranged from 11 to 483 patients over the study period. Mean (±SD) response time was 7.0 (±3.7) minutes, range: 5.3 to 9.3 minutes between hospitals. Mean (±SD) scene time was 13.1 (±5.2) minutes, range: 10.5 to 15.0 minutes between hospitals. Transport time averaged 13.8 (±7.7) minutes, range: 8.3 to 23.8 minutes between hospitals (IQR=8.5-17.9). The mean (±SD) total EMS run time was 33.8 (±10.8) minutes, range: 26.4 to 44.9 minutes between hospitals (IQR=26.4-39.9). Conclusion: Only minor variations in EMS response and scene times were observed across the Stroke Receiving Centers. However, transport time showed greater variation and contributed to the differences in total EMS run times. Many systems had short transport times, limiting prehospital interventions. Next steps include studying factors contributing to transport time variation to inform prehospital care and triage decisions of possible stroke patients to optimize transport times.

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