Quality Assessment of the Management of Road Traffic Fatalities at a Level I Trauma Center Compared with Other Hospitals in Victoria, Australia

1998 ◽  
Vol 45 (4) ◽  
pp. 772-779 ◽  
Author(s):  
D. James Cooper ◽  
Frank T. McDermott ◽  
Stephen M. Cordner ◽  
Ann B. Tremayne
Keyword(s):  
Quality Assessment ◽  
Trauma Center ◽  
Road Traffic ◽  
Traffic Fatalities ◽  
Level I

scholarly journals Prehospital Intervals and In-Hospital Trauma Mortality: A Retrospective Study from a Level I Trauma Center

2020 ◽  
Vol 35 (5) ◽  
pp. 508-515
Author(s):  
Hassan Al-Thani ◽  
Ahammed Mekkodathil ◽  
Attila J. Hertelendy ◽  
Tim Frazier ◽  
Gregory R. Ciottone ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Road Traffic ◽  
Trauma Patients ◽  
Golden Hour ◽  
Chest Injuries ◽  
Life Saving ◽  
Level I ◽  
Prehospital Time ◽  
The Impact

AbstractBackground:The increase in mortality and total prehospital time (TPT) seen in Qatar appear to be realistic. However, existing reports on the influence of TPT on mortality in trauma patients are conflicting. This study aimed to explore the impact of prehospital time on the in-hospital outcomes.Methods:A retrospective analysis of data on patients transferred alive by Emergency Medical Services (EMS) and admitted to Hamad Trauma Center (HTC) of Hamad General Hospital (HGH; Doha, Qatar) from June 2017 through May 2018 was conducted. This study was centered on the National Trauma Registry database. Patients were categorized based on the trauma triage activation and prehospital intervals, and comparative analysis was performed.Results:A total of 1,455 patients were included, of which nearly one-quarter of patients required urgent and life-saving care at a trauma center (T1 activations). The overall TPT was 70 minutes and the on-scene time (OST) was 24 minutes. When compared to T2 activations, T1 patients were more likely to have been involved in road traffic injuries (RTIs); experienced head and chest injuries; presented with higher Injury Severity Score (ISS: median = 22); and had prolonged OST (27 minutes) and reduced TPT (65 minutes; P = .001). Prolonged OST was found to be associated with higher mortality in T1 patients, whereas TPT was not associated.Conclusions:In-hospital mortality was independent of TPT but associated with longer OST in severely injured patients. The survival benefit may extend beyond the golden hour and may depend on the injury characteristics, prehospital, and in-hospital settings.

Establishment, Functioning, Challenges, and One-Year Report of Uttar Pradesh’s First Apex Trauma Center

2019 ◽  
Vol 16 (02/03) ◽  
pp. 099-105
Author(s):  
Mallikarjun Gunjiganvi ◽  
Siddharth Rai ◽  
Rupali Awale ◽  
Amit Agarwal
Keyword(s):  
Trauma Care ◽  
Trauma Center ◽  
Spinal Cord Injuries ◽  
Road Traffic ◽  
Quality Care ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Medical Sciences ◽  
Provide Quality Care ◽  
Level I

AbstractTrauma is a major public health problem across the world with significant morbidity and mortality. Broadly, it is a disease of middle-aged population and is assuming the status of an epidemic in the 21st century. Road traffic injuries are most common followed by railway injuries, industrial, farming, and domestic injuries, and many others in low- and middle-income countries. Severe traumatic brain injuries are the major proportion with concern for long-term cognitive impairment and high spinal cord injuries due to complete dependence. There is no comprehensive trauma care system covering all geography in India at present. The Government of India (GOI), in 2006, established Jai Prakash Narayan Apex Trauma Center, which is run by All India Institute of Medical Sciences at New Delhi as an apex center to provide quality care, training, research, and registry development. It acts as a role model center for the establishment of new centers and helps in upgradation of existing hospitals to provide quality care trauma services. To curb this epidemic of trauma, GOI envisioned National Trauma Care program during the 11th and 12th Five-Year Plans to strengthen the emergency facilities in government hospitals. Many new centers are coming up with various levels of trauma care across the country. Here we discuss the establishment, resources, initial challenges, trauma burden, and a year of report card of the Uttar Pradesh’s first Level I Apex Trauma Center of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, established with a vision of providing state of the art Level I trauma care to the injured victims.

scholarly journals Survival Following Road Traffic Accidents in a Level-I Trauma Center, Parametric versus Semi-Parametric Survival Models

2021 ◽  
Keyword(s):  
Multivariate Analysis ◽  
Survival Analysis ◽  
Statistical Models ◽  
Trauma Center ◽  
Proportional Hazards ◽  
Road Traffic ◽  
Weibull Model ◽  
Parametric Models ◽  
Level I ◽  
Parametric Survival

Background: Simulation studies present an important statistical tool to investigate the performance, properties, and adequacy of statistical models in pre-specified situations. The proportional hazards model of survival analysis is one of the most important statistical models in medical studies. This study aimed to investigate the underlying one-month survival of road traffic accident (RTA) victims in a Level 1 Trauma Center in Iran using parametric and semi-parametric survival analysis models from the viewpoint of post-crash care-provider in 2017. Materials and Methods: This retrospective cohort study (restudy) was conducted at Level-I Trauma Center of Shiraz, Iran, from January to December 2017. Considering the fact that certain covariates acting on survival may take a non-homogenous risk pattern leading to the violation of proportional hazards assumption in Cox-PH, the parametric survival modeling was employed to inspect the multiplicative effect of all covariates on the hazard. Distributions of choice were Exponential, Weibull and Lognormal. Parameters were estimated using the Akaike Results: Survival analysis was conducted on 8,621 individuals for whom the length of stay (observation period) was between 1 and 89 days. In total, 141 death occurred during this time. The log-rank test revealed inequality of survival functions across various categories of age, injury mechanism, injured body region, injury severity score, and nosocomial infections. Although the risk level in the Cox model is almost the same as that in the results of the parametric models, the Weibull model in the multivariate analysis yields better results, according to the Akaike criterion. Conclusion: In multivariate analysis, parametric models were more efficient than other models. Some results were similar in both parametric and semi-parametric models. In general, parametric models and among them the Weibull model was more efficient than other models.

ROAD TRAFFIC FATALITIES AND ACCIDENT RISK IN UTTARAKHAND STATE OF INDIA: A GEOGRAPHICAL ANALYSIS

2020 ◽  
Vol 40 (2) ◽  
pp. 234-247
Author(s):  
Santosh Kumari ◽  
◽  
D.D SHARMA ◽  
VIRENDER SINGH ◽  
◽  
...  
Keyword(s):  
Road Traffic ◽  
Accident Risk ◽  
Traffic Fatalities ◽  
Geographical Analysis

scholarly journals Prehospital time and mortality in polytrauma patients: a retrospective analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
E. Berkeveld ◽  
Z. Popal ◽  
P. Schober ◽  
W. P. Zuidema ◽  
F. W. Bloemers ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Emergency Medical Services ◽  
Trauma Center ◽  
Total Mortality ◽  
Medical Services ◽  
Severely Injured ◽  
Emergency Medical ◽  
Polytrauma Patients ◽  
Level I ◽  
Prehospital Time

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

2021 ◽  
pp. 194338752110206
Author(s):  
Ashton Christian ◽  
Beatrice J. Sun ◽  
Nima Khoshab ◽  
Areg Grigorian ◽  
Christina Y. Cantwell ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Trauma Center ◽  
Demographic Data ◽  
Open Reduction Internal Fixation ◽  
Facial Fractures ◽  
Chi Square ◽  
Single Level ◽  
Baseline Characteristics ◽  
Level I ◽  
Complications And Mortality

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. Methods: We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Results: Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, P = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all P > 0.05). Conclusion: Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.

scholarly journals Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

2021 ◽  
Author(s):  
Carolin A. Kreis ◽  
Birte Ortmann ◽  
Moritz Freistuehler ◽  
René Hartensuer ◽  
Hugo Van Aken ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Trauma Center ◽  
Control Period ◽  
Open Fractures ◽  
Injury Patterns ◽  
Emergency Patient ◽  
Emergency Operations ◽  
Incidence Proportion ◽  
Level I ◽  
The Impact

Abstract Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

scholarly journals Transfer Time After Acceptance to a Level I Trauma Center

2018 ◽  
Vol 2 (2) ◽  
pp. e081
Author(s):  
Ena Nielsen ◽  
David L. Skaggs ◽  
Liam R. Harris ◽  
Lindsay M. Andras
Keyword(s):  
Trauma Center ◽  
Transfer Time ◽  
Level I
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