Socioeconomic status is associated with mechanism and intent of injury in patients presenting to a UK Major Trauma Centre

Snell, Thomas; Lockey, David; Thompson, Dr Julian

doi:10.1016/j.injury.2022.11.023

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…While this study reports the Scottish experience, it is not known to what degree these findings may be replicated in other contexts internationally given variation in the provision of pre-hospital critical care. Findings such as that of more frequent tasking to areas of socioeconomic deprivation, or our quantification of the utility of an aeromedical model in areas of geographic isolation, are likely to be generalisable on the basis of related literature [ 19 , 20 ]; however others, such as the growth in case numbers over time, are likely influenced by local service expansion.…”

Section: Discussionmentioning

confidence: 98%

“…As isolation has the potential to adversely affect health outcomes [ 16 ], these findings reinforce that aeromedical critical care has a role in delivering equitable healthcare, while preserving local resource that may otherwise be diverted to prolonged patient transfer. Pre-hospital critical care may play a role in mitigating health inequalities due to higher rates of dispatch to socioeconomically deprived areas known to suffer greater disease burden, particularly in substance misuse disorders, penetrating trauma, interpersonal violence and self-harm [ 17 – 19 ]. These findings were consistent with a study of retrieval services in Western Australia that reported higher rates of aeromedical retrieval among aboriginal patients, a group experiencing socioeconomic disadvantage [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage

McHenry,

Moultrie,

Cadamy

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background The Emergency Medical Retrieval Service (EMRS) has provided national pre-hospital critical care and aeromedical retrieval in Scotland since 2010. This study investigates trends in the service and patients attended over the last decade; and factors associated with clinical deterioration and pre-hospital death. Methods A retrospective cohort study was conducted of all service taskings over ten years (2011–2020 inclusive). The EMRS electronic database provided data on location, sociodemographic factors, diagnoses, physiological measurements, clinical management, and pre-hospital deaths. Binary logistic regression models were used to determine change in physiology in pre-hospital care, and factors associated with pre-hospital death. Geospatial modelling, using road and air travel time models, was used to explore transfer times. Results EMRS received 8,069 taskings over the study period, of which 2,748 retrieval and 3,633 pre-hospital critical care missions resulted in patient contact. EMRS was more commonly dispatched to socioeconomically deprived areas for pre-hospital critical care incidents (Spearman’s rank correlation, r(8)=-0.75, p = 0.01). In multivariate analysis, systolic blood pressure < 90mmHg, respiratory rate < 6/min or > 30/min, and Glasgow Coma Score ≤ 14 were associated with pre-hospital mortality independent of demographic factors. Geospatial modelling suggested that aeromedical retrieval reduced the mean time to a critical care unit by 1 h 46 min compared with road/ferry transportation. Conclusion EMRS continues to develop, delivering Pre-Hospital and Retrieval Medicine across Scotland and may have a role in addressing health inequalities, including socioeconomic deprivation and geographic isolation. Age, specific distances from care, and abnormal physiology are associated with death in pre-hospital critical care.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage

McHenry,

Moultrie,

Cadamy

et al. 2023

Scand J Trauma Resusc Emerg Med

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“…Understanding relationships between socioeconomic status (SES) and major trauma is important to develop effective injury prevention strategies. This study investigated for such association using retrospective analysis of 5 years’ Trauma and Audit Research Network (TARN) data (2014–2019, n=7666) for adults admitted to a UK major trauma centre 1…”

Section: Socioeconomic Status Is Associated With Mechanism and Intent...mentioning

confidence: 99%

Journal update monthly top five

et al. 2023

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Word count including subheadings & bottom line (excluding references): 1485This month's update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.The papers are ranked as: Worth a peek-interesting, but not yet ready for prime time. Head turner-new concepts. Game changer-this paper could/should change practice.

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“…5 Of those who are diagnosed with diabetes, 24.5% had an HbA1c value of 8.0% or higher, indicating they would benefit from optimized glucose control. 5 The trauma patient population is disproportionately comprised of those of lower socioeconomic status (SES) 6,7 and has demonstrated significant gaps in primary care management of chronic conditions. 8 Another study showed an inverse relationship between SES factors like education and family income and diabetes mortality rates, even after adjusting for age, gender, race/ethnicity, and BMI.…”

Section: Introductionmentioning

confidence: 99%

Diabetes in Trauma Patients: A Potential Gateway to a Medical Home

Hart,

Thames,

Massey

et al. 2024

The American Surgeon™

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Background Diabetes is a major determinant of health outcomes. Trauma patients are disproportionately from lower socioeconomic status, where lack of access to health care prevents timely treatment. Trauma centers could play a role in identifying patients in need of improved glucose management, but the current burden of disease is not known. We assessed the incidence of patients in need of intervention that presented to a level 1 trauma center over a 6-month period. Methods A retrospective chart review over 6 months of all trauma patients admitted to a level 1 trauma center was performed. Patients’ past medical history (PMH), medication reconciliation, and hemoglobin A1c (HbA1c) were recorded on initial assessment; patients <18 years old, lacking an HbA1c, or missing PMH were excluded. Patients with PMH of diabetes or antihyperglycemic use were classified by HbA1c: well-controlled ≤8.0% or poorly controlled >8.0%. Patients with no history of diabetes or antihyperglycemic use were classified based on their HbA1c: non-diabetic <5.7%, pre-diabetic 5.7-6.4%, and undiagnosed diabetic ≥6.5%. Results Overall, 1377 patients were identified. After exclusion criteria, 903 patients were classified as follows: 593 (66%) non-diabetics, 160 (18%) pre-diabetics, and 150 (17%) diabetics. Fifteen diabetics were undiagnosed; 39 of the diagnosed diabetics were poorly controlled. Including pre-diabetics, a total of 214 (24%) trauma patients were in need of improved glycemic control. Discussion One in four trauma patients would benefit from improved outpatient glycemic management, representing a missed opportunity for preventative health care. Trauma centers should develop strategies to meet this need as part of their post-discharge care.

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Socioeconomic status is associated with mechanism and intent of injury in patients presenting to a UK Major Trauma Centre

Cited by 5 publications

References 16 publications

Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage

Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage

Journal update monthly top five

Diabetes in Trauma Patients: A Potential Gateway to a Medical Home

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