Injury-International Journal of the Care of the Injured最新文献

{"title":"Lived experiences of working-age polytrauma patients in Germany - A qualitative Analysis","authors":"Anne Neubert ,&nbsp;Sebastian Hempe ,&nbsp;Carina Jaekel ,&nbsp;Catharina Gaeth ,&nbsp;Christopher Spering ,&nbsp;Katharina Fetz ,&nbsp;Joachim Windolf ,&nbsp;Erwin Kollig ,&nbsp;Dan Bieler ,&nbsp;LeAf-Trauma-Group","doi":"10.1016/j.injury.2024.111938","DOIUrl":"10.1016/j.injury.2024.111938","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system.</div></div><div><h3>Methods</h3><div>Semi-structured exploratory interviews were performed with nine major trauma survivors (18–55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF).</div></div><div><h3>Results</h3><div>Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed.</div></div><div><h3>Discussion</h3><div>The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized.</div></div><div><h3>Implications</h3><div>These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111938"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of the Norwegian trauma protocol. An observational population study from South-Western Norway","authors":"Guro Bjørke ,&nbsp;Ingvild Dalen ,&nbsp;Kenneth Thorsen","doi":"10.1016/j.injury.2024.112063","DOIUrl":"10.1016/j.injury.2024.112063","url":null,"abstract":"<div><h3>Background</h3><div>The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol.</div></div><div><h3>Material and method</h3><div>This was a registry study of a prospectively maintained database in the period from 01/01/2018 to 12/31/2020. Data were collected from the Trauma Registry including prehospital documents. A total of 1519 patients were eligible, of which 95 were excluded, yielding a study population of 1424 patients. All patients were evaluated for a total of 29 criteria in four criteria groups: <em>1 Physiology, 2 Anatomical injury, 3 Mechanism of injury</em>, and <em>4 Special considerations</em>. Overtriage, undertriage, sensitivity and positive predictive value (PPV) were estimated for the current and alternative TTA protocols, criteria groups, and single criteria.</div></div><div><h3>Results</h3><div>The current Norwegian TTA protocol involving criteria groups 1–3 had a total sensitivity of 84.8 %, hence an undertriage of 15.2 % (95 % confidence interval, 11.1–20.3 %), and PPV of 19.2 % hence an overtriage of 80.8 % (78.3–83.1 %). Patients 60 years and older had an undertriage of 21.6 %, whilst patients under 60 years of age had an undertriage of 11.2 %. A TTA protocol including criteria group 4 as well yielded a lower undertriage (5.6 %) without significantly increasing overtriage (81.7 %), and a TTA protocol with criteria group 4 replacing group 3 yielded an undertriage of 7.4 % and an overtriage of 81.0 %. Criteria group <em>3 Mechanism of injury</em> was the criteria group with the most overtriage, at 95 %. Patients that did not meet any criteria had a similar overtriage of 94 %.</div></div><div><h3>Conclusion</h3><div>Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 112063"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent trends and risk factors for chemical and physical restraint use in the emergency department evaluation and treatment of trauma patients","authors":"Jordan M Rook ,&nbsp;Ami Hayashi ,&nbsp;Daniela Salinas ,&nbsp;Yasmine Abbey ,&nbsp;Danielle Newton ,&nbsp;Daniel Carrera ,&nbsp;Jesus G. Ulloa ,&nbsp;Rochelle A. Dicker ,&nbsp;Vickie M. Mays ,&nbsp;Catherine J. Juillard","doi":"10.1016/j.injury.2024.112066","DOIUrl":"10.1016/j.injury.2024.112066","url":null,"abstract":"<div><h3>Background</h3><div>Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use.</div></div><div><h3>Methods</h3><div>This study includes adult trauma activations at a United States urban level I trauma center from January 2016 to July 2022. Data were collected from the trauma registry and medical record. We assessed the use of chemical restraints and physical restraints during care provided in the trauma resuscitation bay and emergency department. We assessed trends over time graphically and with logistic regression. We used multivariable regression models to evaluate associations between restraint use and patient and clinical characteristics and the outcomes of ICU admission, hospitalization duration, and mortality.</div></div><div><h3>Results</h3><div>Of the 8,112 patients, most were male (74.8 %), White (55.8 %), and privately insured (35.2 %). Overall, 8.1 % were restrained with 7.1 % chemically restrained and 2.7 % physically restrained. Overall restraint use increased 254 % (<em>p</em> &lt; 0.001) from 2016 to 2022 driven primarily by a 460 % (<em>p</em> &lt; 0.001) increase in chemical restraint use including a 630 % increase in ketamine administrations (<em>p</em> &lt; 0.001).</div><div>Use of restraints was associated with pre-existing psychotic disorders, intoxication, altered mental status, increasing injury severity, and Medicaid insurance (<em>p</em> &lt; 0.001). Chemical restraint administration was associated with a 3.5 percentage point (95 %CI 1.1–5.9; <em>p</em> = 0.004) increase in the probability of ICU admission and a 1.0 day (95 %CI 0.6–1.4; <em>p</em> &lt; 0.001) increase in hospitalization duration.</div></div><div><h3>Conclusions</h3><div>In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 112066"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing thresholds for shock index in children to identify major trauma","authors":"Sriram Ramgopal ,&nbsp;Jillian K. Gorski ,&nbsp;Pradip P. Chaudhari ,&nbsp;Ryan G. Spurrier ,&nbsp;Christopher M. Horvat ,&nbsp;Michelle L. Macy ,&nbsp;Rebecca E. Cash ,&nbsp;Anne M. Stey ,&nbsp;Christian Martin-Gill","doi":"10.1016/j.injury.2024.111840","DOIUrl":"10.1016/j.injury.2024.111840","url":null,"abstract":"<div><h3>Background</h3><div>An abnormal shock index (SI) is associated with greater injury severity among children with trauma. We sought to empirically-derive age-adjusted SI cutpoints associated with major trauma in children, and to compare the accuracy of these cutpoints to existing criteria for pediatric SI.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the 2021 National Trauma Data Bank (NTDB) Participant Use File. We included injured children (&lt;18 years), excluding patients with traumatic arrests, mechanical ventilation upon hospital presentation, and inter-facility transfers. Our outcome was major trauma defined by the standardized triage assessment tool (STAT) criteria. Our exposure of interest was the SI. We empirically-derived upper and lower cutpoints for the SI using age-adjusted Z-scores. We compared the performance of these to the SI, pediatric-adjusted (SIPA), and the Pediatric SI (PSI). We validated the performance of the cutpoints in the 2019 NTDB.</div></div><div><h3>Results</h3><div>We included 64,326 and 64,316 children in the derivation and validation samples, of whom 4.9 % (derivation) and 4.0 % (validation) experienced major trauma. The empirically-derived age-adjusted SI cutpoints had a sensitivity of 43.2 % and a specificity of 79.4 % for major trauma in the validation sample. The sensitivity of the PSI for major trauma was 33.9 %, with a specificity of 90.7 % among children 1–17 years of age. The sensitivity of the SIPA was 37.4 %, with a specificity of 87.8 % among children 4–16 years of age. Evaluated using logistic regression, patients with an elevated age-adjusted SI had 3.97 greater odds (95 % confidence interval [CI] 3.63–4.33) of major trauma compared to those with a normal age-adjusted SI. Patients with a depressed SI had 1.55 greater odds (95 % CI 1.36–1.78) of major trauma. The area under the receiver operator characteristic curve (AUROC) for the empirically-derived model (0.62, 95 % CI 0.61–0.63) was similar to the AUROC for PSI (0.62, 95 % CI 0.61–0.63); both of which were greater than the SIPA model (0.58, 95 % CI 0.57–0.59).</div></div><div><h3>Conclusion</h3><div>Age-adjusted SI cutpoints demonstrated a mild gain in sensitivity compared to existing measures. However, our findings suggest that the SI alone has a limited role in the identification of major trauma in children.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111840"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying opportunities for community EMS fall prevention","authors":"Tynan H. Friend ,&nbsp;Alexander J. Ordoobadi ,&nbsp;Zara Cooper ,&nbsp;Ali Salim ,&nbsp;Molly P. Jarman","doi":"10.1016/j.injury.2024.111915","DOIUrl":"10.1016/j.injury.2024.111915","url":null,"abstract":"<div><h3>Background</h3><div>Falls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions.</div></div><div><h3>Materials and methods</h3><div>We linked 2019 Healthcare Cost and Utilization Project Massachusetts State Emergency Department (ED) and State Inpatient Databases with American Hospital Association survey data to query ED encounters and inpatient admissions for adults age ≥55 with ED encounters for fall-related injury between July 1, 2019 and December 31, 2019. Univariable descriptive statistics assessed participant characteristics and bivariable tests of significance compared diagnoses, disposition, and hospital characteristics between older adults with and without an EMS encounter in the six months prior to the presenting fall.</div></div><div><h3>Results</h3><div>Of 66,027 older adults who presented with a fall to a Massachusetts ED in July-December 2019, 7,942 (11%) had a prior encounter with EMS in the preceding six months, most of which included an injury diagnosis (99%). Compared to older adults without previous EMS encounters, those with previous EMS encounters were more often in poorer health (17% vs. 10% with multiple or complex comorbidities, <em>p</em> &lt; 0.001) and of lower socioeconomic status (12% vs. 8% in lowest neighborhood income quartile, <em>p</em> &lt; 0.001; 10% vs. 6% enrolled in Medicaid, <em>p</em> &lt; 0.001) compared to those without a prior EMS encounter.</div></div><div><h3>Conclusions</h3><div>A significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111915"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of a regional trauma center in treating combat and civilian casualties. The experience of Assuta Ashdod Hospital in the Iron Swords War","authors":"Itay Zoarets ,&nbsp;Dalia Bider ,&nbsp;Mohamad Molham ,&nbsp;Hanoch Kashtan ,&nbsp;Erez Barenboim","doi":"10.1016/j.injury.2024.111885","DOIUrl":"10.1016/j.injury.2024.111885","url":null,"abstract":"<div><h3>Introduction</h3><div>Assuta Ashdod Hospital is a regional trauma center. The hospital received casualties on the first day of the civilian massacre of October 7th and thereafter. The Assuta Ashdod Hospital was designated as an emergency landing site only for unstable or deteriorating patients who would not survive longer flights to a central trauma center. The aim of this study is to share our experience and challenges as a new regional trauma center in a war zone.</div></div><div><h3>Methods</h3><div>A descriptive cohort study consisting of all trauma patients admitted in the Emergency Department, between October 7, 2023, and December of the same year. The data is part of the Israel National Trauma Registry.</div></div><div><h3>Results</h3><div>A total of 397 heavily wounded patients were admitted, of which 3 were declared dead on arrival, 95 were hospitalized and 299 were discharged from the emergency department after initial care. Of the 95 wounded patients hospitalized, 60 (63.1 %) had a single mechanism of injury, of which, 35.7 % were penetrating injuries. The most frequent injury was to the extremities (60 %) followed by chest and abdomen, 35.7 % and 14.7 % respectively. Multi-trauma injuries were present in 40 % of the wounded patients. The average ISS was 15 (median=9). Of all patients, 10.5 % of patients were considered to have severe and 23.1 % to have profound (very-severe) injuries by the ISS classification. Twelve patients received whole blood transfusions, fourteen received the Massive Transfusion Protocol. Sixty-one of the 95 (64 %) patients underwent surgery, with a total of 137 surgeries performed. Sixty-seven percent of surgical procedures were orthopedic and 16.7 % were of general surgery. The average length of stay was 6.5 days (median=6). We transferred 14 patients to central trauma centers, 3 of which did not survive.</div></div><div><h3>Conclusion</h3><div>The outcomes of patients admitted to the Assuta Ashdod Hospital were good in treating major trauma patients in a mass casualty event, reaffirming its capabilities as an excellent regional trauma center. Therefore, we suggest that the guidelines for evacuation of battle or major casualty events victims only to central trauma centers unless patients are unstable should be reconsidered, and regional trauma centers could effectively share the burden of the treatment of those patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111885"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global, regional, and national burden of burns: An analysis of injury by fire, heat, and hot substances in the global burden of disease study 2019","authors":"Xi Yin ,&nbsp;Shengyu Huang ,&nbsp;Zhihao Zhu ,&nbsp;Qimin Ma ,&nbsp;Yusong Wang ,&nbsp;Xiaobin Liu ,&nbsp;Tuo Shen ,&nbsp;Feng Zhu","doi":"10.1016/j.injury.2024.111955","DOIUrl":"10.1016/j.injury.2024.111955","url":null,"abstract":"<div><h3>Background</h3><div>Burn caused by exposure to hot substances is a common occurrence but there is little data on prevalence trends and disease burden. This research report the burden of burn injuries globally, regionally, and nationally from 1990 to 2019, identify hotspots, and analyze factors affecting disease burden with data from Global Burden of Disease 2019 survey.</div></div><div><h3>Methods</h3><div>The Global Burden of Disease 2019 estimated the incidence, death rate, and disease-adjusted life years (DALY) for injuries due to exposure to fire, heat, and hot substances from 1990 to 2019. For comparison, all rates were age standardized. And the estimated annual percentage change (EAPC) was used to reflect the degree of change of the annual rate.</div></div><div><h3>Results</h3><div>Globally, there were an estimated 8,378,122 (95 % uncertainty interval [UI]: 6,531,887–10,363,109) burn injuries in 2019, with age-standardized incidence, death, and DALY rates of 118 (95 % UI: 89–147), 1.44 (95 % UI: 1.14–1.72), and 96.6 (95 % UI: 75.03–123.05) per 100,000 people, which were 22 %, 43 %, and 43 % lower than those in 1990, respectively. Regionally, age-standardized incidence rate showed a positive association with Socio-demographic Index (SDI) from 1990 to 2019, whereas age-standardized death and DALY rates were negatively associated with SDI. The variation in the age-standardized incidence rate was intrinsic, and the variation in the age-standardized death rate was related to the human development index in the country. The global burn incidence population was skewed, with peaks mainly in the 5 to 19 years age group, but age-specific death rates and disease burden were higher in the under-5 and older age groups.</div></div><div><h3>Conclusions</h3><div>The results of this study indicate the need to consider regional differences in burns when allocating health resources. Despite the reduced global burden of burns, incidence and deaths remain high. Moreover, there are significant differences between regions which are associated with the SDI and the human development index. Additionally, differences exist in the age and sex of the affected populations. Although the exact causes require further study, there is no doubt that the prevention of burns requires serious attention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111955"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variables for reporting studies on extended - focused assessment with sonography for trauma (E-FAST): An international delphi consensus study","authors":"Federico Moro ,&nbsp;Valentina Chiarini ,&nbsp;Tommaso Scquizzato ,&nbsp;Etrusca Brogi ,&nbsp;Marco Tartaglione","doi":"10.1016/j.injury.2024.111931","DOIUrl":"10.1016/j.injury.2024.111931","url":null,"abstract":"<div><h3>Background</h3><div>The Extended Focused Assessment with Sonography for Trauma (E-FAST) is a diagnostic ultrasound technique used in hospital and pre-hospital settings for patients with torso trauma. While E-FAST is common in emergency departments, its pre-hospital use is less routine. This study aims to establish a set of variables for designing studies on pre-hospital E-FAST through a Delphi consensus process involving international experts.</div></div><div><h3>Methods</h3><div>A Delphi consensus process was utilized, involving four rounds of e-mail to the experts. The experts proposed variables for each category, assessed them using a 5-point Likert scale, and voted on whether they should be included in the final template.</div></div><div><h3>Results</h3><div>Out of 14 invited experts, 9 participated in the study. In total, the experts proposed 247 variables. After four rounds, a final list of 32 variables was approved by all experts. These variables related to the system, patient, process, training, imaging, outcome, and others.</div></div><div><h3>Conclusions</h3><div>This Delphi consensus study presents a list of 32 variables for future research studies concerning the use of E-FAST ultrasound in pre-hospital settings. The results of this study are significant as they provide a standardized set of variables that will facilitate the comparison of data obtained from various studies. This will ultimately contribute to the advancement of pre-hospital E-FAST research and practice.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111931"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood far forward: A cross-sectional analysis of prehospital transfusion practices in the Canadian Armed Forces","authors":"Pierre-Marc Dion ,&nbsp;Brodie Nolan ,&nbsp;Christopher Funk ,&nbsp;Colin Laverty ,&nbsp;Jeffrey Scott ,&nbsp;Damien Miller ,&nbsp;Andrew Beckett","doi":"10.1016/j.injury.2024.111771","DOIUrl":"10.1016/j.injury.2024.111771","url":null,"abstract":"<div><h3>Background</h3><div>Canadian Armed Forces (CAF) operate in environments that challenge patient care, especially trauma. Military personnel often find themselves in remote settings without conventional healthcare facilities. Treating traumatic injuries, particularly hemorrhagic shock, often necessitates prehospital blood transfusion. This study aims to present an overview of the current CAF prehospital transfusion practices. Furthermore, the study compared current and developing protocols against expert-recommended guidelines.</div></div><div><h3>Methods</h3><div>A cross-sectional survey design was employed to describe and compare CAF prehospital blood transfusion practices and protocols against expert recommendations. Topics included protocols, equipment, and procedures. An online survey targeted medical leadership and providers within CAF, with data collected from August 15 to December 15, 2023. Results were summarized descriptively. This study received approval from the Unity Health Toronto Research Ethics Board (REB 23–087).</div></div><div><h3>Results</h3><div>Units and teams with prehospital blood transfusion capabilities were contacted, achieving a 100 % response rate. Within CAF, Canadian Special Operations Forces Command (CANSOFCOM), Mobile Surgical Resuscitation Team (MSRT), and Canadian Medical Emergency Response Team (CMERT) possess these capabilities, established between 2013 and 2018. These programs are crucial for military operations. CAF has access to standard blood components, cold Leuko-Reduced Whole Blood (LrWB), and factor concentrates from Canadian Blood Services (CBS), available for both domestic and international missions given adequate planning and favorable conditions. Key findings indicate high adherence to recommended practices, some variability in the transfusion process, and potential benefits of standardizing prehospital transfusion practices.</div></div><div><h3>Conclusions</h3><div>This study provided insights into CAF's implementation of prehospital transfusion practices, highlighting high adherence to national expert recommendations and the importance of structured protocols in military prehospital trauma management.</div></div><div><h3>Implications of key findings</h3><div>CAF's approach and adoption of prehospital transfusion protocols lay a strong foundation for managing trauma patients in remote settings and for expanding prehospital transfusion capabilities across CFHS deployed assets. Further research is needed to advance military trauma care by adapting prehospital blood transfusion to dynamic tactical landscapes and evolving technologies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111771"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interhospital transfers in elderly trauma patients","authors":"Malte Andreas Groth-Rasmussen Koch ,&nbsp;Tobias Arleth ,&nbsp;Oscar Rosenkrantz ,&nbsp;Søren Steemann Rudolph ,&nbsp;Jacob Steinmetz","doi":"10.1016/j.injury.2024.111998","DOIUrl":"10.1016/j.injury.2024.111998","url":null,"abstract":"<div><div><strong>Introduction</strong>: The elderly population is growing worldwide and is more likely to die from injuries that younger patients would likely survive. Furthermore, elderly trauma patients are often subjected to triage decisions that admit them to lower-level facilities. These patients may require interhospital transfer to a major trauma center for definitive care. The aim of this study was to investigate the time interval from arrival at the primary hospital to arrival at the trauma center among elderly trauma patients (≥65 years) as compared to younger, adult patients (18–64 years). We hypothesized that elderly trauma patients would endure a longer time interval.</div><div><strong>Methods</strong>: This was a retrospective quality assurance study based on patient data in our trauma registry at the Trauma Center of Copenhagen University Hospital, Rigshospitalet in Denmark. Data were extracted in the period between 2018 and 2023. We included all adult trauma patients (≥18 years) who underwent interhospital transfer to the trauma center. The primary outcome was minutes from arrival at the primary hospital to arrival at the trauma center. A quality standard of at least 90 % of patients arriving at the trauma center in &lt;240 min after arrival at the primary hospital, was chosen.</div><div><strong>Results</strong>: In total, 565 patients were included and divided into an elderly cohort (<em>n</em> = 184) and a younger cohort (<em>n</em> = 381). The elderly cohort had a significantly longer median delay (247 vs. 197 min; estimated difference 50 min, 95 % confidence interval (CI) [28, 71]; <em>p</em> &lt; 0.001). The elderly cohort met the quality standard less than the younger cohort (49 % vs. 68 %). The elderly cohort had a significantly higher injury severity score (17 [IQR 13, 25] vs. 16 [IQR 9, 21]; <em>p</em> &lt; 0.001), and we found a significant difference in 30-day mortality, which was supported by an adjusted odds ratio of 6.35 (95 % CI [2.84, 15.7]; <em>p</em> &lt; 0.001).</div><div><strong>Conclusions</strong>: In conclusion, elderly trauma patients experienced significantly longer median delays from arrival at the primary hospital to arrival at the trauma center compared to younger adult trauma patients. The elderly trauma patients met the quality standard for transfer time at a lower rate than the younger group.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111998"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}