A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

Bedard, Alexander; Mata, Lina V; Dymond, Chelsea; Moreira, Fábio Tanzillo; Dixon, Julia; Schauer, Steven G; Ginde, Adit A.; Bebarta, Vikhyat S.; Moore, Ernest E.; Mould‐Millman, Nee‐Kofi

doi:10.1186/s12245-020-00324-7

Cited by 25 publications

(10 citation statements)

References 117 publications

(135 reference statements)

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“…Traumatic hemorrhage remains a leading cause of potentially preventable death in civilian and military environments ( Eastridge et al, 2012 ; Spinella and Cap, 2017 ; Dobson et al, 2020 ; Dobson and Letson, 2020 ; Qasim et al, 2022 ). Despite advances in trauma care and treatment guidelines, injury and associated morbidity and mortality rates continue to rise ( Bedard et al, 2020 ). In 2019, Brohi and colleagues set a challenge to trauma surgeons, clinicians and scientists to explain why up to 25% of trauma patients, often admitted to hospital with normalized perfusion and coagulation status, are still dying despite receiving the best medical care ( Brohi et al, 2019 ).…”

Section: A Global Challenge In Trauma Carementioning

confidence: 99%

“…We return to this point later. The patient’s response will depend upon type and severity of trauma, extent of hemorrhage, prehospital factors, hospital care proficiencies, time to surgery, and the patient’s physiological reserve, which itself depends upon age, sex and other genetic and non-genetic factors ( Bedard et al, 2020 ; Dobson et al, 2022a ).…”

Section: Homeostasis Design Tolerances and Physiological Reservementioning

confidence: 99%

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Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma

2022

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Over the years, many explanations have been put forward to explain early and late deaths following hemorrhagic trauma. Most include single-event, sequential contributions from sympathetic hyperactivity, endotheliopathy, trauma-induced coagulopathy (TIC), hyperinflammation, immune dysfunction, ATP deficit and multiple organ failure (MOF). We view early and late deaths as a systems failure, not as a series of manifestations that occur over time. The traditional approach appears to be a by-product of last century’s highly reductionist, single-nodal thinking, which also extends to patient management, drug treatment and drug design. Current practices appear to focus more on alleviating symptoms rather than addressing the underlying problem. In this review, we discuss the importance of the system, and focus on the brain’s “privilege” status to control secondary injury processes. Loss of status from blood brain barrier damage may be responsible for poor outcomes. We present a unified Systems Hypothesis Of Trauma (SHOT) which involves: 1) CNS-cardiovascular coupling, 2) Endothelial-glycocalyx health, and 3) Mitochondrial integrity. If central control of cardiovascular coupling is maintained, we hypothesize that the endothelium will be protected, mitochondrial energetics will be maintained, and immune dysregulation, inflammation, TIC and MOF will be minimized. Another overlooked contributor to early and late deaths following hemorrhagic trauma is from the trauma of emergent surgery itself. This adds further stress to central control of secondary injury processes. New point-of-care drug therapies are required to switch the body’s genomic and proteomic programs from an injury phenotype to a survival phenotype. Currently, no drug therapy exists that targets the whole system following major trauma.

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Section: A Global Challenge In Trauma Carementioning

confidence: 99%

Section: Homeostasis Design Tolerances and Physiological Reservementioning

confidence: 99%

Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma

2022

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“…Trauma is one of the leading causes of morbidity and mortality among all age populations worldwide ( 1 , 2 ). Multiple trauma is common injury at two or more anatomical sites caused by a single consistent injury factor.…”

Section: Introductionmentioning

confidence: 99%

Identification of biomarkers and the mechanisms of multiple trauma complicated with sepsis using metabolomics

Feng

Dai

Liu

et al. 2022

Front. Public Health

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Sepsis after trauma increases the risk of mortality rate for patients in intensive care unit (ICUs). Currently, it is difficult to predict outcomes in individual patients with sepsis due to the complexity of causative pathogens and the lack of specific treatment. This study aimed to identify metabolomic biomarkers in patients with multiple trauma and those with multiple trauma accompanied with sepsis. Therefore, the metabolic profiles of healthy persons designated as normal controls (NC), multiple trauma patients (MT), and multiple trauma complicated with sepsis (MTS) (30 cases in each group) were analyzed with ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS)-based untargeted plasma metabolomics using collected plasma samples. The differential metabolites were enriched in amino acid metabolism, lipid metabolism, glycometabolism and nucleotide metabolism. Then, nine potential biomarkers, namely, acrylic acid, 5-amino-3-oxohexanoate, 3b-hydroxy-5-cholenoic acid, cytidine, succinic acid semialdehyde, PE [P-18:1(9Z)/16:1(9Z)], sphinganine, uracil, and uridine, were found to be correlated with clinical variables and validated using receiver operating characteristic (ROC) curves. Finally, the three potential biomarkers succinic acid semialdehyde, uracil and uridine were validated and can be applied in the clinical diagnosis of multiple traumas complicated with sepsis.

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“…Several studies on the effect of prehospital transport time on mortality have been conducted in the last two decades. In 2020, a scoping review by Bedard et al [ 9 ] on the effect of prehospital time on trauma outcomes was published. They reported on positive, negative, and neutral associations between prehospital time and inhospital mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, studies included in the 2020 scoping review by Bedard et al [ 9 ] were largely based on urban areas with a high population and hospital density. For rural areas, both the incidence and the consequence of traumatic injury exceed those of urban areas, while evidence for the optimal organization of trauma care is less conclusive.…”

Section: Introductionmentioning

confidence: 99%

Assessing Trauma Management in Urban and Rural Populations in Norway: A National Register-Based Research Protocol

Nilsbakken¹,

Sollid²,

Wisborg³

et al. 2022

JMIR Res Protoc

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Background Time is considered an essential determinant in the initial care of trauma patients. In Norway, response time (ie, 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. The recent centralization of trauma services and closure of emergency hospitals have increased prehospital transport distances, predominantly for rural trauma patients. However, the impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described. Objective The project will assess injured patients’ initial pathways through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at the 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 are based on data from the Norwegian Trauma Registry (NTR; studies 1, 2, and 3) and the local Emergency Medical Communications Center (study 2). All injured patients admitted to a Norwegian hospital and registered in the NTR in the period between January 1, 2015, and December 31, 2020, will be included in the analysis. Trauma registry data will be analyzed using descriptive 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 in fall 2020 and was 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. International Registered Report Identifier (IRRID) PRR1-10.2196/30656

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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

Cited by 25 publications

References 117 publications

Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma

Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma

Identification of biomarkers and the mechanisms of multiple trauma complicated with sepsis using metabolomics

Assessing Trauma Management in Urban and Rural Populations in Norway: A National Register-Based Research Protocol

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