Patterns of Early Mortality after Trauma in a Neighborhood Urban Trauma Center: Can We Improve Outcomes?

Berbiglia, Lindsay; Lopez, Peter P.; Bair, Leah; Ammon, Adelaide A.; Navas, Gwyneth; Keller, Melissa; Diebel, Lawrence N.

doi:10.1177/000313481307900815

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…Haemorrhage control was done correctly in 70% in our study vs. 60% in the German/Austrian study, and hypothermia prevention correctly in 62% vs. 42%. In other studies, first aid has been provided correctly in a range from 10.5% to 65% of cases . It is feasible that the difference is due to patients being more lightly injured in our study, or because our study area largely comprises rural areas where bystanders may have had more time to perform measures before the arrival of the EMS than in urban areas, where EMS response times may be shorter.…”

Section: Discussionmentioning

confidence: 92%

“…Reported results, though scarce, are interesting, suggesting that bystander first aid resulted in a possible improvement in survival of 1.8–5%, but how often and how well first aid was provided varied greatly . Two recent studies have reported that injuries were potentially survivable in 6–20% of trauma victims who died either at the scene of injury, during ambulance transportation, or within 4 h of hospital arrival . Thus, optimization of first responder actions may improve survival.…”

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confidence: 99%

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Bystander first aid in trauma – prevalence and quality: a prospective observational study

Bakke

Steinvik

Eidissen

et al. 2015

Acta Anaesthesiol Scand

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BackgroundBystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out‐of‐hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first‐aid providers, and whether previous first‐aid training affects aid quality.MethodsWe conducted a prospective 18‐month study in two mixed urban–rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form.ResultsA total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first‐aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first‐aid providers studied, 35% had some training in first aid. Bystanders with documented first‐aid training gave better first aid than those where first‐aid training status was unknown.ConclusionsA majority of the trauma patients studied received correct pre‐hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first‐aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Bystander first aid in trauma – prevalence and quality: a prospective observational study

Bakke

Steinvik

Eidissen

et al. 2015

Acta Anaesthesiol Scand

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“…Inadequate fluid resuscitation and hemorrhage control were the leading causes of death [ 23 ] among definitely preventable deaths. Inadequate fluid resuscitation was a common problem found in other similar LMIC studies [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths

Roy

Veetil

Khajanchi

et al. 2017

BMC Health Serv Res

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BackgroundA systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery.MethodsAll trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score (ISS) into mild (1–8), moderate (9–15), severe (16–25), profound (26–75) ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable (P), Potentially preventable (PP), Non-preventable (NP) and Non-preventable but care could have been improved (NPI).ResultsDuring the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days (21.6%). The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management (14.3%) and resuscitation with hemorrhage control (16.3%). System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging.ConclusionFifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care.

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“…Patients without signs of life on arrival (i.e., heart rate = 0, systolic blood pressure = 0 and motor component of the Glasgow Coma Scale [GCS] = 1) were also excluded in the belief that they were unable to be resuscitated, regardless of quality of care received. 13…”

Section: Assembly Of Study Cohortmentioning

confidence: 99%

Temporal trends and differences in mortality at trauma centres across Ontario from 2005 to 2011: a retrospective cohort study

et al. 2014

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We observed a significant improvement over time in the mortality of severely injured patients cared for at Ontario's trauma centres. However, considerable differences in trauma centre-specific mortality were observed. Differences were most pronounced among older injured patients and those with isolated traumatic brain injury. System-wide performance improvement initiatives should target these subgroups.

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Patterns of Early Mortality after Trauma in a Neighborhood Urban Trauma Center: Can We Improve Outcomes?

Cited by 10 publications

References 16 publications

Bystander first aid in trauma – prevalence and quality: a prospective observational study

Bystander first aid in trauma – prevalence and quality: a prospective observational study

Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths

Temporal trends and differences in mortality at trauma centres across Ontario from 2005 to 2011: a retrospective cohort study

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