scholarly journals Temporal variation in major trauma admissions

2016 ◽  
Vol 98 (2) ◽  
pp. 128-137 ◽  
Author(s):  
WKM Kieffer ◽  
DV Michalik ◽  
K Gallagher ◽  
I McFadyen ◽  
J Bernard ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Major Trauma ◽  
Injury Severity ◽  
Resource Planning ◽  
Research Network ◽  
University Hospitals ◽  
Significant Seasonal Variation ◽  
Trauma Networks ◽  
The Uk ◽  
Time Of Admission

Introduction Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. Methods Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. Results There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). Conclusions The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.

National temporal variation in major trauma in England, Wales and Northern Ireland

Trauma ◽  
2021 ◽  
pp. 146040862098226
Author(s):  
Will Kieffer ◽  
Daniel Michalik ◽  
Jason Bernard ◽  
Omar Bouamra ◽  
Benedict Rogers
Keyword(s):  
Northern Ireland ◽  
Temporal Variation ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Causes Of Mortality ◽  
Injured Patients ◽  
Time Of Admission

Introduction Trauma is one of the leading causes of mortality worldwide, but little is known of the temporal variation in major trauma across England, Wales and Northern Ireland. Proper workforce and infrastructure planning requires identification of the caseload burden and its temporal variation. Materials and Methods The Trauma Audit Research Network (TARN) database for admissions attending Major Trauma Centres (MTCs) between 1st April 2011 and 31st March 2018 was analysed. TARN records data on all trauma patients admitted to hospital who are alive at the time of admission to hospital. Major trauma was classified as an Injury Severity Score (ISS) >15. Results A total of 158,440 cases were analysed. Case ascertainment was over 95% for 2013 onwards. There was a statistically significant variation in caseload by year (p < 0.0001), times of admissions (p < 0.0001), caseload admitted during weekends vs weekdays, 53% vs 47% (p < 0.0001), caseload by season with most patients admitted during summer (p < 0.0001). The ISS varied by time of admission with most patients admitted between 1800 and 0559 (p < 0.0001), weekend vs weekday with more severely injured patients admitted during the weekend (p < 0.0001) and by season p < 0.0001). Discussion and Conclusion: There is a significant national temporal variation in major trauma workload. The reasons are complex and there are multiple theories and confounding factors to explain it. This is the largest dataset for hospitals submitting to TARN which can help guide workforce and resource allocation to further improve trauma outcomes.

Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK

2020 ◽  
pp. emermed-2019-209092
Author(s):  
James Vassallo ◽  
Gordon Fuller ◽  
Jason E Smith
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Traditional Definition ◽  
Life Saving ◽  
Clinically Significant ◽  
The Uk

IntroductionMajor trauma is the third leading cause of avoidable mortality in the UK. Defining which patients require care in a major trauma centre is a critical component of developing, evaluating and enhancing regional major trauma systems. Traditionally, trauma patients have been classified using the Injury Severity Score (ISS), but resource-based criteria have been proposed as an alternative. The aim of this study was to investigate the relationship between ISS and the use of life-saving interventions (LSI).MethodsRetrospective cohort study using the Trauma Audit Research Network database for all adult patients (aged ≥18 years) between 2006 and 2014. Patients were categorised as needing an LSI if they received one or more interventions from a previously defined list determined by expert consensus.Results193 290 patients met study inclusion criteria: 56.9% male, median age 60.0 years (IQR 41.2–78.8) and median ISS 9 (IQR 9–16). The most common mechanism of injury was falls <2 m (52.1%), followed by road traffic collisions (22.2%). 15.1% received one or more LSIs. The probability of a receiving an LSI increased with increasing ISS, but only a low to moderate correlation was evident (0.334, p<0.001). A clinically significant number of cases (5.3% and 7.6%) received an LSI despite having an ISS ≤8 or <15, respectively.ConclusionsA clinically significant number of adult trauma patients requiring LSIs have an ISS below the traditional definition of major trauma. The traditional definition should be reconsidered and either lowered, or an alternative metric should be used.

scholarly journals Patterns of moderate and severe injury in children after the introduction of major trauma networks

2018 ◽  
Vol 104 (4) ◽  
pp. 366-371 ◽  
Author(s):  
Samantha Jones ◽  
Sarah Tyson ◽  
Michael Young ◽  
Matthew Gittins ◽  
Naomi Davis
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
After School ◽  
Trauma Network ◽  
Body Parts ◽  
Severe Injuries ◽  
Traumatic Injuries ◽  
Trauma Networks ◽  
Outcomes For Children

ObjectiveTo describe the demographics, mechanisms, presentation, injury patterns and outcomes for children with traumatic injuries.SettingData collected from the UK’s Trauma and Audit Research Network.Design and patientsThe demographics, mechanisms of injury and outcomes were described for children with moderate and severe injuries admitted to the Major Trauma Network in England between 2012 and 2017.ResultsData regarding 9851 children were collected. Most (69%) were male. The median age was 6.4 (SD 5.2) years, but infants aged 0.1 year (36.5 days) were the most frequently injured of all ages (0–15 years); 447 (36.0%) of injuries in infants aged <1 year were from suspected child abuse. Most injuries occurred in the home, from falls <2 m, after school hours, at weekends and during the summer. The majority of injuries were of moderate severity (median Injury Severity Score 9.0, SD 8.7). The limbs and pelvis, followed by the head, were the most frequently and most severely injured body parts. Ninety-two per cent were discharged home and 72.8% made a ‘good recovery’ according to the Glasgow Outcome Scale. 3.1% of children died, their median age was 7.0 years (SD 5.8), but infants were the most commonly fatally injured group.ConclusionsA common age of injury and mortality was infants aged <1 year. Accident prevention strategies need to focus on the prevention of non-accidental injuries in infants. Trauma services need to be organised to accommodate peak presentation times, which are after school, weekends and the summer.

1 Simultaneous trauma patients in emergency departments: a difference in mortality?

2018 ◽  
Vol 164 (3) ◽  
pp. 224.1-224
Author(s):  
L Morrow ◽  
T Nutbeam ◽  
O Bouamra
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Icu Stay ◽  
Patient Category ◽  
The Uk ◽  
The Impact

BackgroundThe presentation of multiple simultaneous trauma patients to an Emergency Department is likely to place significant stress and strain on trauma care resources. Currently there is limited literature and no UK or multicentre data available to understand this impact. The aim of this study was to identify patient outcomes when there are simultaneous major trauma patients. We hypothesised that with increasing numbers of simultaneous trauma patients an increase in mortality may be seen.MethodsThe Trauma Audit and Research Network (TARN) database was interrogated from 2010–2015 to identify simultaneous major trauma patients. We defined simultaneous trauma as occurring when there was more than one trauma patient within an Emergency Department at any one time.Patient age, sex, Glasgow Coma Scale and Injury Severity Score (ISS) were recorded. A standardised comparison using a stratified Ws statistic was conducted to compare mortality between groups. Secondary outcomes included length of hospital and intensive care (ICU) stay.ResultsOf 2 07 094 patients, 33.7% were eligible simultaneous trauma patients. 55.7% of patients were male, median age was 61 and median ISS was 9. No increase in mortality was seen with increasing patient numbers (table 1).Abstract 1 Table 1 Ws statistic with increasing simultaneous patient numbersIsolated2 patients3 patients4 patients5 patients6+patientsTotal1 37 360 51 466 13 820 3539 671 185 Ws statistic0.05 0.38 0.72 0.53 0.39 2.70 A statistically significant increase in length of ICU stay was observed for the 6+patient category (p=0.047) but no difference was reported in hospital stay.ConclusionThe impact of simultaneous trauma patients on patient outcomes within the UK has not been previously defined. Simultaneous trauma patients do not appear to have an impact on mortality (as measured by Ws statistic).

scholarly journals Clinical outcomes following major trauma for patients with a diagnosis of depression: a large UK database analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000819
Author(s):  
Jamie Large ◽  
David N Naumann ◽  
Jodie Fellows ◽  
Clare Connor ◽  
Zubair Ahmed
Keyword(s):  
Clinical Outcomes ◽  
Major Trauma ◽  
Injury Severity ◽  
Management Strategies ◽  
Research Network ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Logistic Regression Models ◽  
The Uk

BackgroundMore than a quarter of the UK population are affected by depression during their lifetime. For major trauma patients, postinjury depression can result in poorer long-term outcomes, but there is limited evidence regarding outcomes for patients with pre-existing depression. This study investigated the relationship between a diagnosis of depression prior to hospital admission and clinical outcomes after major trauma.MethodsTrauma patients at a UK major trauma center were identified during a 6.5-year period using the Trauma Audit and Research Network database. Patients with Injury Severity Score >15 who did not die in the emergency department (ED) were included. Logistic regression models were used to compare in-hospital mortality (excluding ED), requirement for surgery, and length of stay (LOS) between those with depression and those without.ResultsThere were 4602 patients included in the study and 6.45% had a diagnosis of depression. Depression was associated with a significant reduction in mortality (OR 0.54, 95% CI 0.30 to 0.91; p=0.026). However, patients with depression were more likely to have longer LOS (OR 124, 95% CI 8.5 to 1831; p<0.001) and intensive care unit LOS (OR 9.69, 95% CI 3.14 to 29.9; p<0.001). Patients with depression were also more likely to undergo surgery (OR 1.36, 95% CI 1.06 to 1.75; p=0.016).DiscussionA pre-existing diagnosis of depression has complex association with clinical outcomes after major trauma, with reduced mortality but longer LOS and higher likelihood of surgical intervention. Further prospective investigations are warranted to inform optimal management strategies for major trauma patients with pre-existing depression.Level of evidenceIII.

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.

scholarly journals Seasonal variation and change trends for quit smoking: evidence from Internet search engine query data

2019 ◽  
Author(s):  
Fang Wang ◽  
Dingtao Hu ◽  
Xiaoqi Lou ◽  
Nana Meng ◽  
Qiaomei Xie ◽  
...  
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Seasonal Variation ◽  
New Zealand ◽  
Google Trends ◽  
Internet Search ◽  
Quit Smoking ◽  
Significant Seasonal Variation ◽  
The Usa ◽  
The Uk

Abstract Background: The outcomes of smoking have generated considerable clinical interest in recent years. Although people from different countries are more interested to the topic of quit smoking during the winter, few studies have tested this hypothesis. The current study aimed to quantify public interest in quit smoking via Google.Methods: We use Google Trends to obtain the Internet search query volume for terms relating to quit smoking for major northern and southern hemisphere countries in this research. Normally search volumes for the term “quit smoking + stop smoking + smoking cessation” were retrieved within the USA, the UK, Canada, Ireland, New Zealand and Australia from January 2004 to December 2018. Seasonal effects were investigated using cosinor analysis and seasonal decomposition of time series models.Results: Significant seasonal variation patterns in those search terms were revealed by cosinor analysis and demonstrated by the evidence from Google Trends analysis in the representative countries including the USA (pcos = 2.36×10-7), the UK (pcos < 2.00×10-16), Canada (pcos < 2.00×10-16), Ireland (pcos <2.00×10-16) ,Australia (pcos = 5.13×10-6) and New Zealand (pcos = 4.87×10-7). Time series plots emphasized the consistency of seasonal trends with peaks in winter / late autumn by repeating in nearly all years. The overall trend of search volumes, observed by dynamic series analysis, declined from 2004 to 2018.Conclusions: The preliminary evidence from Google Trends search tool showed a significant seasonal variation and decreasing trend for the RSV of quit smoking. Our novel findings in smoking cessation epidemiology need to be verified with further studies, and the mechanisms underlying these findings must be clarified.

scholarly journals Helicopter and ground emergency medical services transportation to hospital after major trauma in England: a comparative cohort study

2020 ◽  
Vol 5 (1) ◽  
pp. e000508 ◽  
Author(s):  
Oliver Beaumont ◽  
Fiona Lecky ◽  
Omar Bouamra ◽  
Dhushy Surendra Kumar ◽  
Tim Coats ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Emergency Medical Services ◽  
Major Trauma ◽  
Road Traffic ◽  
Cohort Analysis ◽  
Primary Outcome Measure ◽  
Research Network ◽  
Medical Services ◽  
Emergency Medical ◽  
The Uk

BackgroundThe utilization of helicopter emergency medical services (HEMS) in modern trauma systems has been a source of debate for many years. This study set to establish the true impact of HEMS in England on survival for patients with major trauma.MethodsA comparative cohort design using prospectively recorded data from the UK Trauma Audit and Research Network registry. 279 107 patients were identified between January 2012 and March 2017. The primary outcome measure was risk adjusted in-hospital mortality within propensity score matched cohorts using logistic regression analysis. Subset analyses were performed for subjects with prehospital Glasgow Coma Scale <8, respiratory rate <10 or >29 and systolic blood pressure <90.ResultsThe analysis was based on 61 733 adult patients directly admitted to major trauma centers: 54 185 ground emergency medical services (GEMS) and 7548 HEMS. HEMS patients were more likely male, younger, more severely injured, more likely to be victims of road traffic collisions and intubated at scene. Crude mortality was higher for HEMS patients. Logistic regression demonstrated a 15% reduction in the risk adjusted odds of death (OR=0.846; 95% CI 0.684 to 1.046) in favor of HEMS. When analyzed for patients previously noted to benefit most from HEMS, the odds of death were reduced further but remained statistically consistent with no effect. Sensitivity analysis on 5685 patients attended by a doctor on scene but transported by GEMS demonstrated a protective effect on mortality versus the standard GEMS response (OR 0.77; 95% CI 0.62 to 0.95).DiscussionThis prospective, level 3 cohort analysis demonstrates a non-significant survival advantage for patients transported by HEMS versus GEMS. Despite the large size of the cohort, the intrinsic mismatch in patient demographics limits the ability to statistically assess HEMS true benefit. It does, however, demonstrate an improved survival for patients attended by doctors on scene in addition to the GEMS response. Improvements in prehospital data and increased trauma unit reporting are required to accurately assess HEMS clinical and cost-effectiveness.

scholarly journals Seasonal variation and change trends for quit smoking: evidence from Internet search engine query data

2020 ◽  
Author(s):  
Dingtao Hu ◽  
Xiaoqi Lou ◽  
Nana Meng ◽  
Qiaomei Xie ◽  
Man Zhang ◽  
...  
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Seasonal Variation ◽  
New Zealand ◽  
Google Trends ◽  
Quit Smoking ◽  
Significant Seasonal Variation ◽  
Quitting Smoking ◽  
The Usa ◽  
The Uk

Abstract Background: The outcomes of smoking have generated considerable clinical interest in recent years. Although people from different countries are more interested in the topic of quit smoking during the winter, few studies have tested this hypothesis. The current study aimed to quantify public interest in quitting smoking via Google.Methods: We use Google Trends to obtain the Internet search query volume for terms relating to quit smoking in major northern and southern hemisphere countries in this research. Normally search volumes for the term “quit smoking + stop smoking + smoking-cessation” were retrieved within the USA, the UK, Canada, Ireland, New Zealand and Australia from January 2004 to December 2018. Seasonal effects were investigated using cosinor analysis and seasonal decomposition of time series models.Results: Significant seasonal variation patterns in those search terms were revealed by cosinor analysis and demonstrated by the evidence from Google Trends analysis in the representative countries including the USA (pcos = 2.36×10-7), the UK (pcos < 2.00×10-16), Canada (pcos < 2.00×10-16), Ireland (pcos <2.00×10-16) ,Australia (pcos = 5.13×10-6) and New Zealand (pcos = 4.87×10-7). Time series plots emphasized the consistency of seasonal trends with peaks in winter / late autumn by repeating in nearly all years. The overall trend of search volumes for quitting smoking, observed by dynamic series analysis, has declined from 2004 to 2018.Conclusions: The preliminary evidence from Google Trends search tool showed a significant seasonal variation and a decreasing trend for the RSV of quit smoking. Our novel findings in smoking-cessation epidemiology need to be verified with further studies, and the mechanisms underlying these findings must be clarified.

scholarly journals A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK

2020 ◽  
pp. 026921552097177
Author(s):  
Jade Kettlewell ◽  
Stephen Timmons ◽  
Kay Bridger ◽  
Denise Kendrick ◽  
Blerina Kellezi ◽  
...  
Keyword(s):  
Focus Groups ◽  
Vocational Rehabilitation ◽  
Usual Care ◽  
Major Trauma ◽  
Service Providers ◽  
Psychological Support ◽  
Trauma Survivors ◽  
Systems Methodology ◽  
Trauma Networks ◽  
The Uk

Objective: To identify where and how trauma survivors’ rehabilitation needs are met after trauma, to map rehabilitation across five UK major trauma networks, and to compare with recommended pathways. Design: Qualitative study (interviews, focus groups, workshops) using soft-systems methodology to map usual care across trauma networks and explore service gaps. Publicly available documents were consulted. CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environment) was used as an analytic framework to explore the relationship between stakeholders in the pathway. Setting: Five major trauma networks across the UK. Subjects: 106 key rehabilitation stakeholders (service providers, trauma survivors) were recruited to interviews ( n = 46), focus groups ( n = 4 groups, 17 participants) and workshops ( n = 5 workshops, 43 participants). Interventions: None. Results: Mapping of rehabilitation pathways identified several issues: (1) lack of vocational/psychological support particularly for musculoskeletal injuries; (2) inconsistent service provision in areas located further from major trauma centres; (3) lack of communication between acute and community care; (4) long waiting lists (up to 12 months) for community rehabilitation; (5) most well-established pathways were neurologically focused. Conclusions: The trauma rehabilitation pathway is complex and varies across the UK with few, if any patients following the recommended pathway. Services have developed piecemeal to address specific issues, but rarely meet the needs of individuals with multiple impairments post-trauma, with a lack of vocational rehabilitation and psychological support for this population.

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