Scand J Trauma Resus
-
As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. ⋯ This tool can be used to identify opportunities for improvement in trauma care and guide quality assurance activities. Validation is required in the adult population.
-
Scand J Trauma Resus · Feb 2017
Observational StudyThe impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study.
Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit. ⋯ Helicopter transport of stroke patients was not associated with reduced mortality or disability, nor improved labour market affiliation compared to patients transported by a ground unit.
-
Scand J Trauma Resus · Feb 2017
Potential benefits of an integrated military/civilian trauma system: experiences from two major regional conflicts.
Although differences of opinion and controversies may arise, lessons learned from military conflicts often translate into improvements in triage, resuscitation strategies, and surgical technique. Our fully integrated national trauma system, providing care for both military and civilian casualties, necessitates close cooperation between all aspects of both sectors. We theorized that lessons learned from two regional conflicts over 8 years, with resultant improved triage, reduced hospital length of stay, and sustained low mortality would aid performance improvement and provide evidence of overall trauma system maturation. ⋯ Despite more severe injuries in the most recent regional conflict, there was increased direct triage via helicopter to level 1 centers, reduced inter-hospital transfers, reduced hospital length of stay, and persistent low mortality. Although further assessment is required, these data suggest that via ongoing cooperation in a culture of improved preparedness, an integrated military/civilian national trauma network has also positively impacted civilian results via reduced mortality in ISS ≥ 16 and reduced late inter-hospital transfers. These findings support continued maturation of the system as a whole.
-
Scand J Trauma Resus · Feb 2017
Observational StudyShould capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? Observational case-series study.
Severe accidental hypothermia can cause circulatory disturbances ranging from cardiac arrhythmias through circulatory shock to cardiac arrest. Severity of shock, pulmonary hypoperfusion and ventilation-perfusion mismatch are reflected by a discrepancy between measurements of CO2 levels in end-tidal air (EtCO2) and partial CO2 pressure in arterial blood (PaCO2). This disparity can pose a problem in the choice of an optimal ventilation strategy for accidental hypothermia victims, particularly in the prehospital period. We hypothesized that in severely hypothermic patients capnometry should not be used as a reliable guide to choose optimal ventilatory parameters. ⋯ Severe hypothermia seems to present an example of extremely large Pa-EtCO2 gradient. EtCO2 monitoring does not seem to be a reliable guide to ventilation parameters in severe hypothermia.
-
Scand J Trauma Resus · Feb 2017
Developing quality indicators for physician-staffed emergency medical services: a consensus process.
There is increasing interest for quality measurement in health care services; pre-hospital emergency medical services (EMS) included. However, attempts of measuring the quality of physician-staffed EMS (P-EMS) are scarce. The aim of this study was to develop a set of quality indicators for international P-EMS to allow quality improvement initiatives. ⋯ The expert panel successfully developed a set of quality indicators for international P-EMS. The quality indicators should be prospectively tested for feasibility, validity and reliability in clinical datasets. The quality indicators should then allow for adjusted quality measurement across different P-EMS systems.