Gary Duclos, Fouzia Heireche, Manon Siroutot, Louis Delamarre, Max-Antoine Sartorius, Celine Mergueditchian, Lionel Velly, Julien Carvelli, Aurelia Bordais, Estelle Pilarczyk, Marc Leone
{"title":"严重创伤患者遵守地区指南与死亡率之间的关系：一项观察性回顾研究。","authors":"Gary Duclos, Fouzia Heireche, Manon Siroutot, Louis Delamarre, Max-Antoine Sartorius, Celine Mergueditchian, Lionel Velly, Julien Carvelli, Aurelia Bordais, Estelle Pilarczyk, Marc Leone","doi":"10.1097/MEJ.0000000000001122","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and importance: </strong>Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients.</p><p><strong>Objectives: </strong>The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients.</p><p><strong>Design, settings and participants: </strong>We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items.</p><p><strong>Outcome measures and analysis: </strong>The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24.</p><p><strong>Main results: </strong>A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)].</p><p><strong>Conclusion: </strong>Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"208-215"},"PeriodicalIF":3.1000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association between regional guidelines compliance and mortality in severe trauma patients: an observational, retrospective study.\",\"authors\":\"Gary Duclos, Fouzia Heireche, Manon Siroutot, Louis Delamarre, Max-Antoine Sartorius, Celine Mergueditchian, Lionel Velly, Julien Carvelli, Aurelia Bordais, Estelle Pilarczyk, Marc Leone\",\"doi\":\"10.1097/MEJ.0000000000001122\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and importance: </strong>Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients.</p><p><strong>Objectives: </strong>The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients.</p><p><strong>Design, settings and participants: </strong>We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items.</p><p><strong>Outcome measures and analysis: </strong>The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24.</p><p><strong>Main results: </strong>A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)].</p><p><strong>Conclusion: </strong>Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.</p>\",\"PeriodicalId\":11893,\"journal\":{\"name\":\"European Journal of Emergency Medicine\",\"volume\":\" \",\"pages\":\"208-215\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MEJ.0000000000001122\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MEJ.0000000000001122","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
The association between regional guidelines compliance and mortality in severe trauma patients: an observational, retrospective study.
Background and importance: Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients.
Objectives: The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients.
Design, settings and participants: We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items.
Outcome measures and analysis: The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24.
Main results: A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)].
Conclusion: Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.
期刊介绍：
The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field.
Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community.
Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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