Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation

Tallon, John M.; Fell, Deshayne B.; Karim, Saleema A.; Ackroyd‐Stolarz, Stacy; Petrie, David

doi:10.1503/cjs.016710

Cited by 19 publications

(15 citation statements)

References 36 publications

(56 reference statements)

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“…[5][6][7]16 One of the mechanisms for this is through the provision of prompt access to definitive care at a trauma centre. 17 In Canada, we face challenges in ensuring access to trauma care for citizens living outside urban regions because of our geographic expanse, sparse population densities, limited road access, and inclement weather.…”

Section: Discussionmentioning

confidence: 99%

An inventory of Canadian trauma systems: opportunities for improving access to trauma care

Evans

Tallon

Bridge

et al. 2014

CJEM

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Objective: Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care. Methods: We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region. Results: The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system. Conclusion: There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.

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Section: Discussionmentioning

confidence: 99%

An inventory of Canadian trauma systems: opportunities for improving access to trauma care

Evans

Tallon

Bridge

et al. 2014

CJEM

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“…Organised trauma systems were explored in four papers, 2 from HICs, and 2 from LMICs. The LMIC systems focussed on life support (Basic Life Support by first responders and Advanced Life [insert Table 4] Support by paramedics), whereas the HIC systems included triage, transport, and a multidisciplinary pre-hospital management of patients [68,69,70,71].…”

Section: Secondary Preventionmentioning

confidence: 99%

“…There were also studies on physician-staffed or physician-led EMS, and pre-hospital care training. This goes back to the way the trauma care system and pathways in HICs are designed to include not only life support but a multidisciplinary management of patients and triage in the pre-hospital phase [68,69]. In addition, some HIC trauma care pathways included direct transport to neurosurgical centres, bypassing nearer non-specialist centres [64,108].…”

Section: Strategies and Interventions In Hicsmentioning

confidence: 99%

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: A scoping review

Selveindran

Tango

Khan

et al. 2020

Preprint

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Background Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low-and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs.Methods A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health EBSCO, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).Results A total of 411 publications met the inclusion criteria, including 349 primary studies and 62 reviews. More than 80 percent of the primary studies were from HICs, and described all levels of neurotrauma prevention. Only 65 papers came from LMICs, which mostly described primary prevention, focussing on road safety. For the reviews, 41 papers (66.1%) reviewed primary, 18 tertiary (29.1%), and three secondary preventative approaches. Most of the primary papers in the reviews came from HICs (67.7%) with 5 reviews on only LMIC papers. Fifteen reviews (24.1%) included papers from both HICs and LMICs. Intervention settings ranged from nation-wide to community-based, but were not reported in 44 papers (10.8%), most of which were reviews. Contextual factors were described in 62 papers, and varied depending on the interventions.Conclusions There is a large quantity of global evidence on strategies and interventions for neurotrauma and RTCs prevention. However, less papers were from LMICs, especially on secondary and tertiary prevention. More primary research needs to be done in these countries to determine what strategies and interventions exist, and the applicability of HIC interventions in LMICs.

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“…There is overwhelming evidence demonstrating that modern, regionalized trauma systems have improved injuryrelated mortality by using this paradigm. [48][49][50][51][52][53][54][55][56][57][58][59] Furthermore, there are data suggesting that patients treated at level-1 centers also have improved functional outcomes after an injury, 60-62 with higher patient volumes associated with better outcomes. 63 It is generally thought that the marked improvements in morbidity and mortality with regionalized trauma systems are secondary to more patients with the most severe injuries being treated at level-1 trauma centers and because of a reduction in the time from injury to definitive treatment through rapid triage and transport.…”

Section: Limiting the Number Of Stroke Centersmentioning

confidence: 99%

Needed Dialog

Fargen

Jauch

Khatri

et al. 2015

Stroke

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Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation

Cited by 19 publications

References 36 publications

An inventory of Canadian trauma systems: opportunities for improving access to trauma care

An inventory of Canadian trauma systems: opportunities for improving access to trauma care

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: A scoping review

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