Direct transport vs secondary transfer to level I trauma centers in a French exclusive trauma system: Impact on mortality and determinants of triage on road-traffic victims

Hamada, Sophie; Delhaye, Nathalie; Degoul, Samuel; Gauss, Tobias; Raux, Mathieu; Devaud, Marie-Laure; Amani, Johan; Cook, Fabrice; Hego, Camille; Duranteau, Jacques; Rouquette, Alexandra

doi:10.1371/journal.pone.0223809

Cited by 22 publications

(18 citation statements)

References 49 publications

(53 reference statements)

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“…This may, in part, explain why an association between secondary transfer and increased mortality has not been reported uniformly. A recent analysis 29 of a French regional trauma system found no increased mortality associated with secondary transfer . This might be expected to be comparable to the UK system, but the authors suggested that results may reflect the very specific system of physician‐led prehospital care within their trauma system.…”

Section: Discussionmentioning

confidence: 95%

Time to definitive care within major trauma networks in England

et al. 2020

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Background: Significant mortality improvements have been reported following the implementation of English trauma networks. Timely transfer of seriously injured patients to definitive care is a key indicator of trauma network performance. This study evaluated timelines from emergency service (EMS) activation to definitive care between 2013 and 2016. Methods: An observational study was conducted on data collected from the UK national clinical audit of major trauma care of patients with an Injury Severity Score above 15. Outcomes included time from EMS activation to: arrival at a trauma unit (TU) or major trauma centre (MTC); to CT; to urgent surgery; and to death. Results: Secondary transfer was associated with increased time to urgent surgery (median 7⋅23 (i.q.r. 5⋅48-9⋅28) h versus 4⋅37 (3⋅00-6⋅57) h for direct transfer to MTC; P < 0⋅001) and an increased crude mortality rate (19⋅6 (95 per cent c.i. 16⋅9 to 22⋅3) versus 15⋅7 (14⋅7 to 16⋅7) per cent respectively). CT and urgent surgery were performed more quickly in MTCs than in TUs (2⋅00 (i.q.r. 1⋅55-2⋅73) versus 3⋅15 (2⋅17-4⋅63) h and 4⋅37 (3⋅00-6⋅57) versus 5⋅37 (3⋅50-7⋅65) h respectively; P < 0⋅001). Transfer time and time to CT increased between 2013 and 2016 (P < 0⋅001). Transfer time, time to CT, and time to urgent surgery varied significantly between regional networks (P < 0⋅001). Conclusion: Secondary transfer was associated with significantly delayed imaging, delayed surgery, and increased mortality. Key interventions were performed more quickly in MTCs than in TUs.

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Section: Discussionmentioning

confidence: 95%

Time to definitive care within major trauma networks in England

et al. 2020

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“…Domain invariance was assessed through uniform and non-uniform differential item functioning (DIF) for age (6 categories), gender, and education level (3 categories); differences of ≥ 0.5 logits in item difficulties were considered meaningful [ 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

The Norwegian PROMIS-29: psychometric validation in the general population for Norway

Garratt

Coste

Rouquette

et al. 2021

J Patient Rep Outcomes

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Background The Patient Reported Outcome Measurement Information System profile instruments include “high information” items drawn from large item banks following the application of modern psychometric criteria. The shortest adult profile, PROMIS-29, looks set to replace existing short-form instruments in research and clinical practice. The objective of this study was to undertake the first psychometric evaluation of the Norwegian PROMIS-29, following a postal survey of a random sample of 12,790 Norwegians identified through the National Registry of the Norwegian Tax Administration. Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, gender, and education. PROMIS-29 scores were compared to those for the EQ-5D-5L and the Self-assessed Comorbidity Questionnaire (SCQ), for purposes of assessing validity based on a priori hypotheses. Results There were 3200 (25.9%) respondents with a mean age (SD) of 51 (20.7, range 18 to 97 years) and 55% were female. The PROMIS-29 showed satisfactory structural validity and acceptable fit to Rasch model including unidimensionality, and measurement invariance across age and education levels. One pain interference item had uniform DIF for gender but splitting gave satisfactory fit. Domain reliability estimates ranged from 0.85 to 0.95. Correlations between PROMIS-29 domain, SCQ and EQ-5D scores were largely as expected, the largest being for scores assessing very similar aspects of health. Conclusions The Norwegian version of the PROMIS-29 is a reliable and valid generic self-reported measure of health in the Norwegian general population. The instrument is recommended for further application, but the analysis should be replicated and responsiveness to change assessed in future studies before it can be recommended for clinical and health services evaluation in Norway.

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“…In addition, this study only considers patients who were admitted alive at the hospital. It is impossible to assess whether the number of severely traumatized patients who died in the pre-hospital setting has not increased [18].…”

Section: Limitationsmentioning

confidence: 99%

Impact of the SARS-COV-2 outbreak on epidemiology and management of major traumain France: a registry-based study (the COVITRAUMA study)

Moyer

James

Gakuba

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017–2019). Results Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017–2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017–2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. Conclusions During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.

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Direct transport vs secondary transfer to level I trauma centers in a French exclusive trauma system: Impact on mortality and determinants of triage on road-traffic victims

Cited by 22 publications

References 49 publications

Time to definitive care within major trauma networks in England

Time to definitive care within major trauma networks in England

The Norwegian PROMIS-29: psychometric validation in the general population for Norway

Impact of the SARS-COV-2 outbreak on epidemiology and management of major traumain France: a registry-based study (the COVITRAUMA study)

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