Background As trauma systems mature, they are expected to improve patient care, reduce in-hospital complications and optimize outcomes. Qatar has a single trauma center, at the Hamad General Hospital, which serves as the hub for the trauma system that was verified as a level 1 trauma system by the Accreditation Canada International Distinction program in 2014. We hypothesized that this international accreditation was a major step, in the maturation process of the Qatar trauma system, that has positively impacted patient care, reduced complications and improved outcomes of trauma patients in such a rapidly developing country. Methods A retrospective analysis of data was conducted for all trauma patients who were admitted between 2010 and 2018. Data were obtained from the level 1 trauma center registry at Hamad Medical Corporation. Patients were divided into Group 1- pre-accreditation (admitted from January 2010 to October 2014) and Group 2- post-accreditation (admitted from November 2014 to December 2018). Patients’ characteristics and in-hospital outcomes were analyzed and compared. Data included patients’ demographics; injury types, mechanism and injury severity scores, interventions, hospital stay, complications and mortality (pre-hospital and in-hospital). Time series analysis for mortality was performed using expert modeler. Results Data from a total of 15,864 patients was collected and analyzed. Group 2 patients had more severe injuries in comparison to Group 1 (p<0.05). However, Group 2, had a lower complication rate (ventilator associated pneumonia (VAP)) and a shorter mean hospital length of stay (p<0.05). The overall mortality was 8%. In Group 2; the pre-hospital mortality was higher (52% vs. 41%, p = 0.001), while in-hospital mortality was lower (48% vs. 59%) compared to Group 1 (p = 0.001). Conclusions The international recognition and accreditation of the trauma center in 2014 was the key factor in the maturation of the trauma system that improved the in-hospital outcomes. Accreditation also brought other benefits including a reduction in VAP and hospital length of stay. However, further studies are required to explore the maturation process of all individual components of the trauma system including the prehospital setting.
BackgroundHelicopter emergency medical services (HEMS) have become a standard element of advanced pre-hospital care system. Positive outcomes in HEMS transportation were evident in different settings and certain types of patients. The present study assessed presentations and outcomes in trauma patients transported by HEMS and ground emergency medical services (GEMS) in Qatar.MethodsA retrospective review of trauma registry data at Hamad Trauma Centre (HTC) was conducted for trauma patients transported by GEMS and HEMS in the duration from 2011 to 2013. Patients were classified into two groups based on the mode of transportation (HEMS vs GEMS). Injury severity score (ISS) was defined as severe/profound trauma (>15) and mild/moderate trauma (≤ 15). Mortality was defined as brought in dead (BID), within the first day, within the first week and more than 1 week.ResultsA total of 4596 patients with traumatic injuries were included (7% HEMS). When compared with GEMS, the mean ISS, Head AIS and scene GCS were greater in HEMS (p = 0.001). Nearly 12% of ISS > 15 and 5% of ISS ≤ 15 were transported by HEMS. The main mechanism of injury was motor vehicle crash (MVC) (37%) followed by fall (25%) and pedestrians (14%). MVC victims were more likely to be transported by HEMS whereas fall and pedestrians victims were frequently transported by GEMS (p < 0.05). On-scene rate of intubation was higher in HEMS irrespective of ISS score (p = 0.001). Overall mortality, in-hospital deaths and BID was 10.2%, 7.5% and 3%; respectively. The mortality was 2.5-fold higher in victims transported by HEMS compared with GEMS (10% vs 4%, p = 0.001). Mortality within the first day and more than one week were higher with HEMS, however, it was greater within the first week in GEMS. Age and mode of transportation -adjusted predictors of mortality were ISS and scene GCS.ConclusionsMVCs are the main mechanism of injury in Qatar. Polytrauma and scene GCS play important prognostic role regardless the mode of transportation. These findings indicate the need of more effective preventive measure on the road
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