Changing the System — Major Trauma Patients and Their Outcomes in the NHS (England) 2008–17

Crawford, S Michael

doi:10.1016/j.eclinm.2018.11.001

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…There are few studies focusing on geriatric severe trauma. Measurement of outcome in geriatric trauma is mostly limited to mortality [6].…”

Section: Discussionmentioning

confidence: 99%

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Reduced Recovery Capacity After Major Trauma in the Elderly: Results of a Prospective Multicenter Registry-Based Cohort Study

Freigang¹,

Müller²,

Ernstberger³

et al. 2020

JCM

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Aims: Considering the worldwide trend of an increased lifetime, geriatric trauma is moving into focus. Trauma is a leading cause of hospitalization, leading to disability and mortality. The purpose of this study was to compare the global health-related quality of life (HRQoL) of geriatric patients with adult patients after major trauma. Methods: This multicenter prospective registry-based observational study compares HRQoL of patients aged ≥65 years who sustained major trauma (Injury Severity Score (ISS) ≥ 16) with patients <65 years of age within the trauma registry of the German Trauma Society (DGU). The global HRQoL was measured at 6, 12, and 24 months post trauma using the EQ-5D-3L score. Results: We identified 405 patients meeting the inclusion criteria with a mean ISS of 25.6. Even though the geriatric patients group (≥65 years, n = 77) had a lower ISS (m = 24, SD = 8) than patients aged <65 years (n = 328), they reported more difficulties in each EQ dimension compared to patients <65 years. Contrary to patients < 65, the EQ-5D Index of the geriatric patients did not improve at 12 and 24 months after trauma. Conclusions: We found a limited HRQoL in both groups after major trauma. The group of patients ≥65 showed no improvement in HRQoL from 6 to 24 months after trauma.

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“…There are few studies focusing on geriatric severe trauma. Measurement of outcome in geriatric trauma is mostly limited to mortality [6].…”

Section: Discussionmentioning

confidence: 99%

“…In general, major trauma research applies mortality for the measurement of initial trauma severity and outcome [6]. Using patient-centered analysis methods like the multidimensional EQ-5D (European Quality of Life 5 Dimensions) score requires a more demanding longitudinal follow up [7].…”

Section: Introductionmentioning

confidence: 99%

Reduced Recovery Capacity After Major Trauma in the Elderly: Results of a Prospective Multicenter Registry-Based Cohort Study

Freigang¹,

Müller²,

Ernstberger³

et al. 2020

JCM

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“…Regional reconfiguration of trauma services, including ECT deployment, has been associated with improvements in both care processes and outcomes. 4 Pre-hospital airway management in major trauma is a National Institute for health and Care Excellence (NICE) quality measure. Patients who cannot maintain their airway or adequate ventilation should have definitive airway management within 45 min of the initial emergency call.…”

mentioning

confidence: 99%

Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study

Turner

Bourn

Raitt

et al. 2020

British Journal of Anaesthesia

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Background: Up to one in eight trauma patients arrive at a hospital with a partially or completely obstructed airway. The UK National Institute for health and Care Excellence (NICE) practice guidelines recommend that trauma patients requiring anaesthesia for definitive airway management receive this care within 45 min of an emergency call, preferably at the incident scene. How frequently this target is achieved remains unclear. We assessed the recorded time to prehospital emergency anaesthesia after trauma across UK helicopter emergency medical service (HEMS) units. Methods: We retrospectively recorded time to pre-hospital emergency anaesthesia across all 20 eligible UK HEMS units (comprising 52 enhanced care teams) from April 1, 2017 to March 31, 2018. Times recorded for emergency notification, dispatch, arrival, and neuromuscular blocking agent administration were analysed. Results: HEMS undertook 1755 pre-hospital emergency anaesthetics for trauma across the UK during the study period. There were 1176/1755 (67%) episodes undertaken by helicopter response teams during daylight hours. The median time to pre-hospital emergency anaesthesia was 55 min (inter-quartile range: 45e70); anaesthesia within 45 min of the initial emergency call was achieved in 25% cases. Delayed dispatch time (>9 min) was associated with fewer patients receiving pre-hospital anaesthesia within 45 min (odds ratio: 7.7 [95% confidence intervals: 5.8e10.1]; P<0.0001). Conclusions: The time to achieve pre-hospital emergency anaesthesia by UK HEMS frequently exceeds the recommended 45 min target. Reducing the time to dispatch of emergency medical teams may impact on the delivery of prehospital emergency anaesthesia.

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“…In fact, as I pointed out in a letter to the journal, the apparently favourable outcome of this seems simply to result from incomplete data collection in the first year of observations. 5…”

Section: Assessing the Benefit Of Centralisationmentioning

confidence: 99%

How to provide specialist services: how do we know when centralisation is a good idea?

Crawford

2020

Postgraduate Medical Journal

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Changing the System — Major Trauma Patients and Their Outcomes in the NHS (England) 2008–17

Cited by 6 publications

References 2 publications

Reduced Recovery Capacity After Major Trauma in the Elderly: Results of a Prospective Multicenter Registry-Based Cohort Study

Reduced Recovery Capacity After Major Trauma in the Elderly: Results of a Prospective Multicenter Registry-Based Cohort Study

Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study

How to provide specialist services: how do we know when centralisation is a good idea?

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