scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry

2021 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management.Methods: This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics.Results: A total of 30,551 patients (physician-led: 2,976, paramedic-led: 27,575) were eligible for analysis, of whom 2,690 propensity score-matched pairs (physician-led: 2,690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1,718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age <65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time <60 min were likely to benefit from physician-led prehospital management.Conclusions: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry

2020 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. Methods: This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. Results: A total of 30,551 patients (physician-led: 2,976, paramedic-led: 27,575) were eligible for analysis, of whom 2,690 propensity score-matched pairs (physician-led: 2,690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1,718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age <65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time <60 min were likely to benefit from physician-led prehospital management. Conclusions: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: a retrospective analysis of the Japanese nationwide trauma registry

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. Methods This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. Results A total of 30,551 patients (physician-led: 2976, paramedic-led: 27,575) were eligible for analysis, of whom 2690 propensity score-matched pairs (physician-led: 2690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age < 65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time < 60 min were likely to benefit from physician-led prehospital management. Conclusions Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

scholarly journals Effectiveness of Physician-Led Prehospital Management in Severe Trauma Patients: A Retrospective Analysis of the Japanese Nationwide Trauma Registry

2020 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Trauma Registry ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Trauma Management ◽  
Transport Time ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: The comparative effectiveness of physician-led over paramedic-led prehospital trauma management has been inconclusive. Regarding this topic, in some previous studies, the impacts of physician-led prehospital management were affected by the advantage of shortened prehospital time by helicopter transportation. This study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time.Methods: This retrospective cohort study analyzed the data of severe trauma patients who were transported directly to a hospital during 2009–2018 using Japan’s nationwide trauma registry. In-hospital mortality was compared between patients who received physician-led prehospital management and those who received paramedic-led management, using 1:4 propensity score-matched analysis. The propensity score was calculated using information on patient demographics, mechanism of injury, and vital signs at the scene of injury, as well as prehospital transport time. Subgroup analysis was performed to identify patients who were most likely to benefit from physician-led prehospital management.Results: A total of 30,968 patients (physician-led: 3,032, paramedic-led: 27,936) were eligible for analysis, of whom 2,766 propensity score-matched pairs (i.e., physician-led: 2766, paramedic-led: 11,064) were generated and compared. Physician-led pre-hospital trauma management showed significant superiority over paramedic-led prehospital trauma management (in-hospital mortality: 395 [14.3%] and 1785 [16.1%], respectively; odds ratio [95% confidence interval] = 0.87 [0.77–0.97], p = 0.017). In subgroup analysis, cases characterized by patient age <65 years, Injury Severity Score ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and prehospital transport time <60 min likely benefitted from physician-led prehospital management.Conclusions: The result of a largescale registry-based cohort study showed that physician-led prehospital trauma management was significantly associated with survival benefit independent of prehospital transport time. The findings may provide a basis for future research to assess effective physician-provided treatments in prehospital-field.

Dispatch, Prehospital time, Interventions and Outcomes in a Norwegian Trauma population – assessing initial trauma management in urban and rural areas. The DIONT-project: a national registry-based research protocol (Preprint)

2021 ◽  
Author(s):  
Inger Nilsbakken ◽  
Stephen Sollid ◽  
Torben Wisborg ◽  
Elisabeth Jeppesen
Keyword(s):  
Statistical Methods ◽  
Rural Areas ◽  
Trauma Registry ◽  
Trauma System ◽  
Trauma Patients ◽  
Trauma Management ◽  
Trauma Systems ◽  
Urban And Rural Areas ◽  
Prehospital Time ◽  
The Impact

BACKGROUND Time is considered an essential determinant in the initial care of trauma patients. In Norway, the particular time indicator response time (i.e. time from dispatch center call to ambulance arrival at scene) is a controversial national quality indicator. However, no national requirements for response times have been established. There is an ongoing debate regarding the optimal configuration of the Norwegian trauma system. Recent centralization of trauma services and closure of emergency hospitals have increased distances for prehospital transports, predominantly for rural trauma patients. The impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described. OBJECTIVE The project will assess the injured patient´s initial pathway through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at a national level and existing evidence for an optimal organization of trauma care is still inconclusive regarding the impact of prehospital time. METHODS Three quantitative registry-based retrospective cohort studies are planned. The studies based on data from the Norwegian Trauma Registry (NTR) (Study 1, 2 and 3) and local Emergency Medical Communications Center (EMCC) data (Study 2). All injured adult patients admitted to a Norwegian hospital and registered in the NTR in the period 1st of January 2015 to 31st of December 2020 will be included in the analysis. Trauma registry data will be analyzed using descriptive statistical methods and relevant statistical methods to compare prehospital time in rural and central areas including regression analyses and adjusting for confounders. RESULTS The project received funding autumn 2020 and is approved by the Oslo University Hospital data protection officer, case number 18/02592. Registry data including approximately 40.000 trauma patients will be extracted during the first quarter of 2022 and analysis will begin immediately thereafter. Results are expected to be ready for publication from the third quarter of 2022. CONCLUSIONS : Findings from the study will contribute to new knowledge regarding existing quality indicators and with an increasing centralization of hospitals and residents, the study will contribute to further development of the Norwegian trauma system. A high generalizability to other trauma systems is expected, given the similarities between demographical changes and trauma systems in many high-income countries.

Blood Transfusion is an Independent Predictor of Mortality after Blunt Trauma

2007 ◽  
Vol 73 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Anthony Charles ◽  
Almaasa Shaikh ◽  
Madonna Walters ◽  
Susan Huehl ◽  
Richard Pomerantz
Keyword(s):  
Logistic Regression ◽  
Blood Transfusion ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Trauma Registry ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Trauma Population ◽  
Transfusion Requirements ◽  
Level 2

Allogeneic blood transfusion is associated with increased morbidity and mortality. The authors evaluated the affect of blood transfusion, independent of injury severity on mortality. The authors conducted a retrospective review of all patients, age ≥18 years with blunt injury admitted to their Level 2 trauma center from 1994 to 2004 by query of the NTRACS trauma registry. Initial systolic blood pressure and heart rate determined the shock index. Logistic regression was used to model the affect of blood transfusion on mortality. Transfusion requirements were categorized as follows: A, 0 U; B, 1 to 2 U; C, 3 to 5 U; D, ≥6 U blood. In this sample of 8215 blunt trauma patients, 324 patients received blood transfusion. Mortality rates between the transfused and nontransfused groups were 15.12 per cent and 1.84 per cent ( P < 0.000) respectively. In the logistic regression model, transfusion category B did not have a significant affect on the odds of death ( P = 0.176); the affect of transfusing 3 to 5 U and ≥6 U had a mortality odds ratio of 3.22 ( P = 0.002) and 4.87 ( P = 0.000) respectively. Transfusing ≥2U blood was strongly associated with mortality in this blunt trauma population. There must be a continuous attempt to limit blood transfusion when feasible and physiologically appropriate.

40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma?

2010 ◽  
Vol 76 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Jay Menaker ◽  
Deborah M. Stein ◽  
Allan S. Philp ◽  
Thomas M. Scalea
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Trauma Registry ◽  
Clinical Symptoms ◽  
Multidetector Ct ◽  
Trauma Patients ◽  
Mri Findings ◽  
Persistent Symptoms ◽  
Operative Repair ◽  
Ct Technology

We have recently demonstrated that 16-slice multidetector CT (MDCT) is insufficient for cervical spine (CS) clearance in patients with unreliable examinations after blunt trauma. The purpose of this study was to determine if a negative CS CT using 40-slice MDCT is sufficient for ruling out CS injury in unreliable blunt trauma patients or if MRI remains necessary for definitive clearance. In addition, we sought to elucidate the frequency by which MRI alters treatment in patients with a negative CS CT who have a reliable examination with persistent clinical symptoms. The trauma registry was used to identify all patients with blunt trauma who had a negative CS CT on admission using 40-slice MDCT and a subsequent CS MRI during their hospitalization from July 2006 to July 2007. Two hundred thirteen patients were identified. Overall, 24.4 per cent patients had abnormal MRIs. Fifteen required operative repair; 23 required extended cervical collar; and 14 had collars removed. A total of 8.3 per cent of patients with an unreliable examination and 25.6 per cent of reliable patients had management changed based on MRI findings. Overall, MRI changed clinical practice in 17.8 per cent of all patients. Despite newer 40-slice CT technology, MRI continues to be necessary for CS clearance in patients with unreliable examinations or persistent symptoms.

scholarly journals Characteristics, injuries, and clinical outcomes of geriatric trauma patients in Japan: an analysis of the nationwide trauma registry database

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yukari Miyoshi ◽  
Yutaka Kondo ◽  
Yohei Hirano ◽  
Tadashi Ishihara ◽  
Koichiro Sueyoshi ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Japanese Society ◽  
Trauma Registry ◽  
Economic Problem ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Age Group ◽  
Epidemiological Characteristics ◽  
Registry Database

Abstract Geriatric trauma is a major socio-economic problem, especially among the aging Japanese society. Geriatric people are more vulnerable to trauma than younger people; thus, their outcomes are often severe. This study evaluates the characteristics of geriatric trauma divided by age in the Japanese population. We evaluated trauma characteristics in patients (n = 131,088) aged ≥ 65 years by segregating them into 2 age-based cohorts: age 65–79 years (65–79 age group; n = 70,707) and age ≥ 80 years (≥ 80 age group; n = 60,381). Clinical characteristics such as patient background, injury mechanism, injury site and severity, treatment, and outcome were examined. Injuries among men were more frequent in the 65–79 age group (58.6%) than in the ≥ 80 age group (36.3%). Falls were the leading cause of trauma among the 65–79 age group (56.7%) and the ≥ 80 age group (78.9%). In-hospital mortality was 7.7% in the 65–79 age group and 6.6% in the ≥ 80 age group. High fall in the ≥ 80 age group showed 30.5% mortality. The overall in-hospital mortality was 11.8% (the 65–79 age group, 12.3%; the ≥ 80 age group, 11.2%). Most hospitalized patients were transferred to another hospital (the 65–79 age group, 52.5%; the ≥ 80 age group, 66.2%). We demonstrated the epidemiological characteristics of Japanese geriatric trauma patients. The overall in-hospital mortality was 11.8%, and fall injury in the ≥ 80 age group required caution of trauma care.

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