Comparison of routine blood alcohol tests and ICD-10-AM coding of alcohol involvement for major trauma patients

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% ( n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair ( κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

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Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients

Injury ◽

10.1016/j.injury.2016.01.016 ◽

2016 ◽

Vol 47 (3) ◽

pp. 640-645 ◽

Cited By ~ 21

Author(s):

B. Relja ◽

J. Menke ◽

N. Wagner ◽

B. Auner ◽

M. Voth ◽

...

Keyword(s):

Interleukin 6 ◽

Major Trauma ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Trauma Patients ◽

Blood Alcohol

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92 Increased Proportion of Alcohol-Related Trauma in A South London Major Trauma Centre During Lockdown, A Cohort Study

British Journal of Surgery ◽

10.1093/bjs/znab258.062 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Brown ◽

T Smith ◽

A Gaukroger ◽

P Tsinaslanidis ◽

C Hing

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Blood Alcohol ◽

Regression Analyses ◽

Electronic Patient Records ◽

Staffing Levels ◽

The United Kingdom ◽

Major Trauma Centre ◽

Significant Difference

Abstract Background Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. Method All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N = 316), and 1st April – 31st May 2020 (lockdown; N = 191) had electronic patient records analysed. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses. Results Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%); (Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%); OR -0.40, 95% CI -0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05). Conclusions UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global ‘waves’ of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

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The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-99-16 ◽

2013 ◽

Vol 99 (1) ◽

pp. 16-19

Author(s):

D Potter ◽

A Kehoe ◽

JE Smith

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Trauma Centre ◽

Research Network ◽

Trauma Network ◽

Trauma Patients ◽

Major Trauma Centre ◽

Injury Assessment ◽

Trauma Response ◽

Retrospective Database

AbstractThe identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.

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Prehospital critical care is associated with increased survival in adult trauma patients in Scotland

Emergency Medicine Journal ◽

10.1136/emermed-2019-208458 ◽

2020 ◽

Vol 37 (3) ◽

pp. 141-145 ◽

Cited By ~ 2

Author(s):

Alistair Maddock ◽

Alasdair R Corfield ◽

Michael J Donald ◽

Richard M Lyon ◽

Neil Sinclair ◽

...

Keyword(s):

Multivariate Analysis ◽

Critical Care ◽

Major Trauma ◽

Injury Severity ◽

Prehospital Care ◽

National Registry ◽

Trauma Centre ◽

Trauma Patients ◽

Data Set ◽

Major Trauma Centre

BackgroundScotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally.MethodsNational registry-based retrospective cohort study using 2011–2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables.ResultsOur data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p<0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01).ConclusionPrehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.

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Audit of pelvic binder placement in trauma patients arriving at a major trauma centre

International Journal of Surgery ◽

10.1016/j.ijsu.2018.05.546 ◽

2018 ◽

Vol 55 ◽

pp. S114

Author(s):

Z. Gundkalli ◽

S. Lancaster ◽

M. Deakin

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Trauma Patients ◽

Pelvic Binder ◽

Major Trauma Centre

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Missed orthopaedic injuries in adult trauma patients at a major trauma centre

Trauma ◽

10.1177/1460408614568829 ◽

2015 ◽

Vol 17 (2) ◽

pp. 123-127 ◽

Cited By ~ 2

Author(s):

Christopher D Roche ◽

Colin M McDonald ◽

Bruce Liu ◽

Aisha Razik ◽

Tim Bishop

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Trauma Patients ◽

Major Trauma Centre ◽

Orthopaedic Injuries

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Health status and return to work in trauma patients at 3 and 6 months post-discharge: an Australian major trauma centre study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-015-0558-0 ◽

2015 ◽

Vol 42 (4) ◽

pp. 483-490 ◽

Cited By ~ 7

Author(s):

M. M. Dinh ◽

K. Cornwall ◽

K. J. Bein ◽

B. J. Gabbe ◽

B. A. Tomes ◽

...

Keyword(s):

Health Status ◽

Return To Work ◽

Major Trauma ◽

Trauma Centre ◽

Trauma Patients ◽

Post Discharge ◽

Centre Study ◽

Major Trauma Centre

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P9 Impact of the relocation of a regional neuroscience service on major trauma patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.89 ◽

2019 ◽

Vol 90 (3) ◽

pp. e28.2-e28

Author(s):

C Cabaret ◽

M Nelson ◽

M Foroughi

Keyword(s):

Major Trauma ◽

Strong Association ◽

Trauma Centre ◽

Trauma Patients ◽

Major Trauma Centre ◽

Significant Difference ◽

Ct Head ◽

The Mean ◽

The Impact ◽

Mean Time

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.

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Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre

Australian Health Review ◽

10.1071/ah14205 ◽

2016 ◽

Vol 40 (4) ◽

pp. 385

Author(s):

Michael M. Dinh ◽

Kendall J. Bein ◽

Delia Hendrie ◽

Belinda Gabbe ◽

Christopher M. Byrne ◽

...

Keyword(s):

Quality Improvement ◽

Cost Effectiveness ◽

Incremental Cost ◽

Major Trauma ◽

Cost Effective ◽

Trauma Centre ◽

Trauma Patients ◽

Trauma Service ◽

Major Trauma Centre ◽

Improvement Programs

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007–12) compared with the pre-intervention period (2001–06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91 million, of which $2.86 million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P = 0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.

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