Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters

Hsieh, Shang-Lin; Hsiao, Chien-Han; Chiang, Wen-Chu; Shin, Sang Do; Jamaluddin, Sabariah Faizah; Son, Do Ngoc; Hong, Ki Jeong; Sun, Jen Tang; Tsai, Weide; Chien, Ding-Kuo; Chang, Wenhan; Chen, Tse-Hao

doi:10.1007/s00068-021-01816-8

Cited by 19 publications

(21 citation statements)

References 26 publications

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“…In trauma imaging, timely diagnosis and intervention are crucial to patient survival and improved outcomes [ 4 ]. Despite the transformative power of PACS workstations on radiology workflow efficiencies, technical limitations nonetheless still exist which can delay image transfer from the CT scanner to the PACS.…”

Section: Discussionmentioning

confidence: 99%

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

et al. 2022

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Background Radiology trainees were uncomfortable going to the CT scanner to review trauma panscans and interacting with trauma surgeons. Objective This study aims to determine if radiology residents can be trained to accurately identify injuries requiring immediate surgical attention at the CT scanner. Methods A high-fidelity simulation model was created to provide an immersive training experience. Between February 2015 and April 2017, 62 class 1 trauma panscans were read at the CT scanner by 11 PGY-3 radiology residents. Findings made at the scanner were compared to resident preliminary and attending radiology reports and correlated with clinical outcomes. Timestamps were recorded and analyzed. Surveys were administered to assess the impact of training on radiology residents’ self-confidence and to assess trauma surgeons’ preference for radiology at the scanner. Significance level was set at p < 0.05. Results The mean time to provide results at the CT scanner was 11.1 min. Mean time for the preliminary report for CT head and cervical spine was 24.4 ± 9.8 min, and for the CT chest, abdomen, and pelvis was 16.3 ± 6.9 min. 53 traumatic findings on 62 panscans were identified at the scanner and confirmed at preliminary and final reports, for a concordance rate of 85%, compared to 72% for the control group. Radiology residents agreed or strongly agreed the training prepared them for trauma panscan reporting. Trauma surgeons shifted in favor of radiology presence at the scanner. Conclusion Radiology residents can be trained to accurately and rapidly identify injuries requiring immediate surgical attention at the CT scanner. Clinical impact These findings support the value-added of an in-person radiologist at the CT scanner for whole-body trauma panscans to facilitate timely detection of life-threatening injuries and improve professional relations between radiologists and trauma surgeons.

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Section: Discussionmentioning

confidence: 99%

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

et al. 2022

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“…Table 1 summarizes the characteristics of the included studies 9,16–38 . The two largest studies contributed 56.2% (5,716 of 10,168) of the included patients, 18,25 and 15 of 24 studies contained more than 100 patients.…”

Section: Resultsmentioning

confidence: 99%

The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review

Lamb

Tran

Lampron

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Uncontrolled bleeding is a common cause of preventable mortality in trauma. While it is intuitive that delays to hemostasis may lead to worse outcomes, the impacts of these delays remain incompletely explored. This systematic review aimed to characterize the extant definitions of delayed hemostatic intervention and to quantify the impacts of delays on clinical outcomes. METHODS We searched EMBASE, MEDLINE, and Web of Science from inception to August 2022. Studies defining “delayed intervention” and those comparing times to intervention among adults presenting to hospital with blunt or penetrating injuries who required major hemostatic intervention were eligible. The coprimary outcomes were mortality and the definition of delay to hemostasis used. Secondary outcomes included units of packed red blood cells received, length of stay in hospital, and length of stay in intensive care. RESULTS We identified 2,050 studies, with 24 studies including 10,168 patients meeting the inclusion criteria. The majority of studies were retrospective observational cohort studies, and most were at high risk of bias. A variety of injury patterns and hemostatic interventions were considered, with 69.6% of studies reporting a statistically significant impact of increased time to intervention on mortality. Definitions of delayed intervention ranged from 10 minutes to 4 hours. Conflicting data were reported for impact of time on receipt of blood products, while one study found a significant impact on intensive care length of stay. No studies assessed length of stay in hospital. CONCLUSION The extant literature is heterogeneous with respect to injuries included, methods of hemostasis employed, and durations of delay examined. While the majority of the included studies demonstrated a statistically significant relationship between time to intervention and mortality, an evidence-informed definition of delayed intervention for bleeding trauma patients at large has not been solidified. In addition, standardized research is needed to establish targets, which could reduce morbidity and mortality. LEVEL OF EVIDENCE Systematic Review; Level IV.

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“…Finally, some traumatic events may not require time-sensitive interventions, such as distal limb fractures or traumatic brain injury [ 21 22 ]. In patients with major traumatic and torso injuries, a shorter time to definitive care is positively associated with survival and functional outcomes [ 23 ]. Nonlife-threatening injuries may not require time-dependent intervention.…”

Section: Discussionmentioning

confidence: 99%

“…However, in this study, we did not adjust the time to definitive care for survival in trauma patients because of the limitations of our dataset. In previous studies, delay in the time to definitive care may impair functional outcomes and is positively associated with the mortality rate in the traumatic population [ 23 27 ]. Third, our study used subgroup analysis to show the association between “weekend effect” and “holiday season effect” and mortality in the elder population and shock condition population, as a useful guild for emergency physician to early alert.…”

Section: Discussionmentioning

confidence: 99%

The impact of holiday season and weekend effect on traumatic injury mortality: Evidence from a 10-year analysis

Lin

Liu

et al. 2023

Tzu Chi Med J

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A BSTRACT Objectives: Trauma is one of the leading causes of death and its incidence increases annually. The “weekend effect” and “holiday season effect” on traumatic injury mortality remain controversial, whereby traumatic injury patients admitted during weekends and/or holiday season have a higher risk of in-hospital death. The present study is aimed to explore the association between “weekend effect” and “holiday season effect” and mortality in traumatic injury population. Materials and Methods: This retrospective descriptive study included patients from the Taipei Tzu Chi Hospital Trauma Database between January 2009 and June 2019. The exclusion criterion was age of < 20 years. The primary outcome was the in-hospital mortality rate. The secondary outcomes included intensive care unit (ICU) admission, ICU re-admission, length of stay (LOS) in the ICU, ICU admission duration ≥ 14 days, total hospital LOS, total hospital LOS ≥ 14 days, need for surgery, and re-operation rate. Results: In this study, 11,946 patients were included in the analysis, and 8143 (68.2%) patients were admitted on weekdays, 3050 (25.5%) on weekends, and 753 (6.3%) on holidays. Multivariable logistic regression revealed that the admission day was not associated with an increased risk of in-hospital mortality. In other clinical outcome analyses, we found no significant increase in the risk of in-hospital mortality, ICU admission, ICU LOS ≥ 14 days, or total LOS ≥ 14 days in the weekend and holiday season groups. The subgroup analysis showed that the association between holiday season admission and in-hospital mortality was noted only in the elderly and shock condition populations. The holiday season duration did not differ in terms of in-hospital mortality. Longer holiday season duration was also not associated with an increased risk of in-hospital mortality, ICU LOS ≥14 days, and total LOS ≥14 days. Conclusion: In this study, we did not find any evidence that weekend and holiday season admissions in the traumatic injury population were associated with an increased risk of mortality. In other clinical outcome analyses, there was no significant increase in the risk of in-hospital mortality, ICU admission, ICU LOS ≥ 14 days, or total LOS ≥ 14 days in the weekend and holiday season groups.

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Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters

Cited by 19 publications

References 26 publications

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review

The impact of holiday season and weekend effect on traumatic injury mortality: Evidence from a 10-year analysis

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