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Level I Trauma Centre (level + i_trauma_centre)
Selected AbstractsTriage and mortality in 2875 consecutive trauma patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010R. MEISLER Background: Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage. Methods: We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality. Results: We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily (n=82) or secondarily triaged (n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the level I trauma centre and 48 min on transportation. Severe injury with an injury severity score >15 was seen in 345 patients, of whom 118 stayed at the local hospital. They had a significantly higher mortality than 116 of those secondarily transferred [45/118, 38.1% vs. 11/116, 9.7% (P<0.0001)]. Mortality within 30 days was 4.3% in admitted patients, and significant risk factors of death were violence [odds ratio (OR)=5.72], unconsciousness (OR=4.87), hypotension (OR=4.96), injury severity score >15 (OR=27.42), and age. Conclusions: Around 50% of all trauma deaths occurred at the scene. Increased survival of severely injured patients may be achieved by early transfer to highly specialised care. [source] Evaluation of pre-hospital trauma triage criteria: a prospective study at a Danish level I trauma centreACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2007S. H. Kann Background:, The aim of the present study was to evaluate the precision of our trauma triage protocol [based on the American College of Surgeons, Committee on Trauma (ACS COT)] in identifying severely injured defined as an injury severity score (ISS) > 15. Our hypothesis was that isolated mechanism-of-injury criteria were responsible for a significant over-triage leading to over-use of our trauma team. Methods:, Design: A prospective cohort study. Setting: A level I trauma centre, Aarhus, Denmark. Patients and participants: Among all injured patients admitted during a 6-month period in 2003 we identified severely injured. During the study period, trauma team activations were consecutively registered and triage criteria were prospectively collected. Sensitivity, specificity, positive predictive value, over-triage and under-triage were calculated. Results:, Out of 15,162 patients in the emergency department, 848 injured patients were included and 59 (7%) were severely injured. We had 242 trauma team activations with 54 (22%) severely injured. Sensitivity was 92%, specificity 76%, giving an over-triage of 24% and an under-triage of 8%. The positive predictive value was 22%. Among 60 patients with mechanism-of-injury as the only criterion, five were severely injured in contrast to 12 out of 20 patients with mechanism-of-injury combined with physiological and/or anatomical criteria. Conclusion:, The positive predictive value of our triage protocol was low, only 22%. This was mainly as a result of a significant over-triage from isolated mechanism-of-injury criteria. We recommend revision of the triage protocol and reallocation of our trauma team resources. [source] Iatrogenic tracheal rupture in children: A retrospective studyTHE LARYNGOSCOPE, Issue 3 2009Eva-Maria Schedlbauer MD Abstract Objectives: Iatrogenic injuries to the trachea are rare, but life-threatening complaints. Causes and treatment methods have been described for adults, but there is no literature on aetiology and treatment in children. We performed a retrospective study to examine the frequency, aetiology, and treatment of iatrogenic injuries to the trachea in children and to develop guidelines for their treatment and prevention. Methods: Retrospective study from 2000,2007 at a level I trauma centre. All iatrogenic injuries to the trachea between the cricoid cartilage and the level of the carina in children (ages 0,16) were included in the study. Results: Between 2000 and 2007, 18 tracheal injuries were treated, four of them in children (22%). The primary symptom in all cases was emphysema. Diagnosis was confirmed using flexible endoscopy. In all cases, the cause of the injury was intubation. Two cases of acute injury were treated conservatively by bridging the injury with a tube. Two cases were treated surgically by means of end-to-end anastomosis. In all cases, healing by first intention occurred. No stenoses were observed during follow-up endoscopy. Conclusions: Acute tracheal ruptures in children can be treated conservatively by bridging the rupture with a tube. Injuries to the trachea in which the mucosa is damaged or in which other complications, such as fistulae, are present must be treated surgically. The prognosis for such injuries is good. Laryngoscope, 2009 [source] Cost-effectiveness and quality-of-life analysis of physician-staffed helicopter emergency medical services,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2009A. N. Ringburg Background: The long-term health outcomes and costs of helicopter emergency medical services (HEMS) assistance remain uncertain. The aim of this study was to investigate the cost-effectiveness of HEMS assistance compared with emergency medical services (EMS). Methods: A prospective cohort study was performed at a level I trauma centre. Quality-of-life measurements were obtained at 2 years after trauma, using the EuroQol,Five Dimensions (EQ-5D) as generic measure to determine health status. Health outcomes and costs were combined into costs per quality-adjusted life year (QALY). Results: The study population receiving HEMS assistance was more severely injured than that receiving EMS assistance only. Over the 4-year study interval, HEMS assistance saved a total of 29 additional lives. No statistically significant differences in quality of life were found between assistance with HEMS or with EMS. Two years after trauma the mean EQ-5D utility score was 0·70 versus 0·71 respectively. The incremental cost,effectiveness ratio for HEMS versus EMS was ,28 327 per QALY. The sensitivity analysis showed a cost-effectiveness ratio between ,16 000 and ,62 000. Conclusion: In the Netherlands, the costs of HEMS assistance per QALY remain below the acceptance threshold. HEMS should therefore be considered as cost effective. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuriesBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2005C. Elton Background: There are conflicting views on the accuracy of computed tomography (CT) findings in patients with bowel and mesenteric injuries (BMIs) following blunt abdominal trauma. The aim of the present study was to assess the accuracy of the CT report during a trauma call. Methods: Ninety-eight patients underwent preoperative abdominal spiral CT and subsequent laparotomy following blunt trauma between January 1996 and March 2001 at a level I trauma centre. The immediate results of the scans were reported by the on-call radiology registrar and written in the medical notes by the trauma team leader. Seventy of the 98 preoperative abdominal CT scans were retrieved from the radiology department and reported by two consultant radiologists with a special interest in trauma radiology. Results: The sensitivity and specificity of the 70 expert CT reports were 80 (95 per cent confidence interval (c.i.) 66 to 94) and 78 (95 per cent c.i. 65 to 90) per cent respectively for diagnosing a BMI. The sensitivity and specificity of the immediate CT reports were 93 (95 per cent c.i. 84 to 100) and 71 (95 per cent c.i. 60 to 83) per cent respectively. Conclusion: Spiral CT is highly sensitive for detecting a BMI following blunt abdominal trauma. This sensitivity is maintained when the scan is reported by a radiology registrar. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | ||||||||||