Improve Trauma Care Research Articles

Comparison of Emergency Trauma Score (EMTRAS) with Rapid Emergency Medicine Score (REMS) for Prediction of Early Mortality in Adult Trauma Patients

Background: Trauma is an injury to living tissue from an external source. The severity of traumatic injuries plays a crucial role in the determination of mortality in patients with trauma, thus a proper understanding of the severity of trauma is very important for improving trauma care. Several scoring systems are available for the objective, initial assessment of the severity of injury to help treatment strategy. Aim of the study was to compare Emergency Trauma Score (EMTRAS) with Rapid Emergency Medicine Score (REMS) for prediction of early mortality in adult trauma patients. Methods: Study was conducted with 100 patients of either sex, age 18 years or above with history of trauma due to road accident, fall and assault. REMS and EMTRAS score was calculated from the laboratory and patient characteristics mentioned in the Trauma scoring datasheet, within 30 minutes of arrival of the patient in the hospital and 24 hours after hospitalization. Results: Comparison of the REMS score within 30 mins of patient arrival and at 24 hrs was statistically significant (p=0.0099). Comparison of EMTRAS SCORE Within 30 mins of patient arrival and at 24 hrs was not statistically significant (p=0.0505). Comparison of REMS vs Outcome at 24 hrs (Non-Survivors and Survivors) was statistically significant (p=<0.0001). Comparison of EMTRAS vs Outcome at 24 hrs (Non-Survivors and Survivors) was statistically significant (p=<0.0001). Comparison of AUROC (Area Under the Receiver Operating Characteristics) of REMS and EMTRAS were 0.689 and 0.789 respectively, which was statistically significant. Conclusion: We conclude that both REMS and EMTRAS are easy, accurate predictors of in-hospital early mortality in Adult Trauma Patients. But in our study, EMTRAS AUROC was greater than AUROC of REMS. Hence EMTRAS should have good prognostic power for predicting in-hospital early mortality in Adults Trauma patients.

Data-driven readiness: A preliminary report on cataloging best practices in military civilian partnerships.

Between conflicts, many of the combat casualty care lessons learned are lost as the nation shifts priorities and providers leave the military. Solutions are needed to bridge the knowledge gap created by interwar periods. One of the foremost solutions is partnerships between civilian trauma centers and the military health system. Over the past two decades, a myriad of military-civilian partnerships (MCPs), which vary in their composition, duration, and focus, was created. The objective of this report is to describe the initial attempt of the Department of Defense to catalog existing MCPs to inform both civilian and military stakeholders. This initial catalog is intended as a reference to aid in future MCP development and facilitate the synchronization of efforts to improve trauma care delivery and readiness. Using methodology from the Institute of Defense Analysis, the total number of eligible trauma centers in the United States was determined. The Institute of Defense Analysis determined eligibility-based American College of Surgeons Trauma Center verification or state trauma center designation. Each military service provided their list of MCPs, which were categorized. Military-civilian partnerships were cataloged by various characteristics and program components. Key variables include number and type of personnel trained, duration of training, and focus, for example, team versus individual focused and training versus maintaining proficiency focused. A total of 1,139 hospitals in the United States are potentially eligible for MCPs. There are at least 87 unique partnerships; the majority are part-time sustainment MCPs. The Air Force has the largest number of providers in MCPs. There are many challenges to maintain accurate and up to date data on MCPs. With the collated information, the Defense Health Agency, military services, special operations community, and civilian partners will be better empowered to optimize the readiness value of their programs and better prepare our military medical providers for the nation's and military's future needs.

Reduction of motorcycle-related deaths over 15\xa0years in a developing country

BackgroundThere have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates.MethodsThis is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied.ResultsThe incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test).ConclusionsThe incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.

Management of pancreatic trauma in urban India: A multicenter study

BackgroundPancreatic trauma occurs in 0.2–2% of patients with blunt trauma and 1–12% of patients with penetrating trauma. The mortality and morbidity rates range from 9 to 34% and 30–60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India. MethodsWe analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’. ResultsOf the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma, 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), bowel (14) and spleen (13) were the most common associated injuries. ConclusionConservative management was as common as operative management in patients with pancreatic injuries. Most (80%) grade III/IV underwent operative treatment. Many patients (82%) had associated injuries. Level of evidenceIII.

Effect of Delay of Care for Patients with Craniomaxillofacial Trauma in Rwanda.

ObjectivesCraniomaxillofacial (CMF) trauma represents a significant proportion of global surgical disease burden, disproportionally affecting low- and middle-income countries where care is often delayed. We investigated risk factors for delays to care for patients with CMF trauma presenting to the highest-volume trauma hospital in Rwanda and the impact on complication rates.Study DesignThis prospective cohort study comprised all patients with CMF trauma presenting to the University Teaching Hospital of Kigali, Rwanda, between June 1 and October 1, 2020.SettingUrban referral center in resource-limited setting.MethodsEpidemiologic data were collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications.ResultsFifty-four patients (94.4% men) met criteria for inclusion. The mean age was 30 years. A majority of patients presented from a rural setting (n = 34, 63%); the most common cause of trauma was motor vehicle accident (n = 18, 33%); and the most common injury was mandibular fracture (n = 28, 35%). An overall 78% of patients had delayed treatment of the fracture after arrival to the hospital, and 81% of these patients experienced a complication (n = 34, P = .03). Delay in treatment was associated with 4-times greater likelihood of complication (odds ratio, 4.25 [95% CI, 1.08-16.70]; P = .038).ConclusionDelay in treatment of CMF traumatic injuries correlates with higher rates of complications. Delays most commonly resulted from a lack of surgeon and/or operating room availability or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.

Association of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries

Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population. To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level. This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data analysis was performed from January 1 to June 31, 2021. Preinjury health was measured using 2013 claims, and outcomes were measured through 2016. The population was stratified by anatomical injury pattern. Propensity scores for level I trauma center treatment were estimated using the Abbreviated Injury Scale, age, and residential proximity to trauma center and then used to match beneficiaries from each trauma level (I, II, III, and IV/non-trauma centers) by injury type. Admitting hospital's trauma center level. Case fatality rates (CFRs) at 30 and 365 days after injury, estimated in the matched sample using multivariable, hierarchical logistic regression models. A total of 433 169 Medicare beneficiaries (mean [SD] age, 82.9 [8.3] years; 68.4% female; 91.5% White) were included in the analysis. A total of 206 275 (47.6%) were admitted to non-trauma centers and 161 492 (37.3%) to level I or II trauma centers. Patients with isolated extremity fracture had the fewest deaths (365-day CFR ranged from 16.1% [95% CI, 11.2%-22.4%] to 17.4% [95% CI, 11.8%-24.6%] by trauma center status). Patients with both hip fracture and traumatic brain injury had the most deaths (365-day CFRs ranged from 33.4% [95% CI, 25.8%-42.1%] to 35.8% [95% CI, 28.9%-43.5%]). These findings suggest that older adults do not benefit from existing trauma center care, which is designed with younger patients in mind. There is a critical need to improve trauma care practices to address common injury mechanisms and types of injury in older adults.

Healthcare disparities in trauma: why they exist and what we can do.

This review will explore the underlying causes of healthcare disparities among trauma patients and offer considerations for reducing inequities to improve trauma care. Newly recognized racial disparities exist with respect to triaging trauma patients and in acute pain management. Social Determinants of Health offers a model to understand disparity in trauma care. Race, ethnicity, socioeconomic status, and access to healthcare drive outcome disparity among trauma patients. These disparities include reduced healthcare services, inadequate pain management, reduced postdischarge care, and increased mortality. Increasing workforce diversity may mitigate implicit bias and improve cultural competency. Social determinants of health impact the disparities in trauma care and offer a framework to address care through creative solutions.

An Autopsy Based Study on Fatal Road Traffic Accidents in the Mortuary of Patna Medical College, Patna (Bihar)

Road Traffic Accidents (RTA) continue to be one of the leading causes of death in developing countries andconstitute a medico-legal autopsy case conducted in India.Objective: To study the demographic profile and pattern of injuries among victims of RTA.Materials and Methodology: Autopsy based study was carried out in the department of Forensic Medicine &amp;Toxicology, in the Mortuary of Patna Medical College, Patna from September 2018 to September 2021. The datasource included post-mortem reports, police inquest reports. History noted in the sheet as given by relatives andfriends of the deceased, crime scene, photographs, hospital, case records and laboratory investigation reports. Thedata collected was analyzed and descriptive statistics such as percentages, ratios and proportion were used.Observation and Results: A total of 8120 autopsies were conducted during the study period and among them 2030(25%) cases were of RTA of these 6334 (78%) were males and 1786 (21.99%) female. Majority of the victims 23.49%were in the age group of 21-30 years. Head injury 76.99% was the most common cause of death and subduralhaemorrhage (80.68%) was the commonest among the intracranial haemorrhages.Conclusion: Road traffic accidents are preventable cause of mortality and there is urgent need to enhance roadsafety by multi sector approach along with improving trauma care management in hospitals.

Benchmarking performance in emergency medical services for improving trauma care: A data driven approach

ObjectiveWe propose a data-driven approach, that can be used by any state or region, to cluster county-level emergency medical services (EMS) and subsequently benchmark them against their peers using over- (OT) and under-triage (UT) rates as performance measures. MethodsThe approach consists of three phases: data collection, clustering, and benchmarking. Collected data includes EMS trauma-specific capabilities, volume, and performance improvement activities aggregated at the county level. Clustering approaches include K-means, K-medoids, and CLARANS. Benchmarking of EMS performance in each county against its peer within the same cluster was conducted using guidelines from the American College of Surgeons (ACS) on over- (OT) and under-triage (UT) rates. To illustrate our data-driven approach, we used data collected from the state of Ohio (OH). This included a survey of 318 EMS agencies across 87 counties in the state of OH, and 6002 deidentified patient records from 2012 obtained from the state of Ohio's EMS Division. ResultsOur proposed approach can handle both qualitative and quantitative data. It is capable of identifying key factors that allow for grouping of counties as peers, in a cluster, to enable subsequent benchmarking. Application of our approach on the state of OH data revealed that county-type (rural vs urban), number of trauma-related runs, number of paid vs. voluntary employees, and additional resources provided by EMS agencies in the county (to help with well-being and coping mechanisms for EMS providers) were key factors in clustering. A small number of clusters appeared sufficient to group counties based on various EMS attributes. Benchmarking based on ACS guidelines revealed a large variation in UT and OT rates among counties in the same cluster. Rates up to 3–4 times higher were observed in several counties compared to the best performing county in that cluster, even though some of these counties had better capabilities. ConclusionOur novel, data-driven approach can enable any regional or state EMS agency in the United States (US) to quantitatively compare counties with their peers in the same cluster and help unravel new insights that could be used to target cluster-specific interventions that can achieve improved outcomes.

Validating the trauma care system developed by Yokohama City local government

BackgroundSince becoming the city with the first government‐designated major trauma center in 2014, Yokohama has been striving to centralize care for extensive trauma patients. Hence, in this study, the Yokohama City Major Trauma Care Advisory Committee tested the efficacy of the centralization of care for trauma patients.MethodsThis investigation included all cases of deaths due to road traffic accidents that occurred in the 2‐year period following the establishment of the major trauma center. The probability of survival was calculated using data provided by the police and fire departments. Cases that died despite having a probability of survival of 50% or more were included in the survey undertaken by physicians recommended by the Japanese Association for the Surgery of Trauma, who visited the hospitals.ResultsOf those surveyed, preventable trauma death accounted for 1 case (1.7%) and potentially preventable trauma death accounted for 7 (11.9%), compared with 5 (9.8%) and 11 (21%) cases, respectively, in the period 2009–2010.ConclusionsComparing the survey conducted before establishment of the major trauma center, those results support the benefits of centralizing care for severe trauma cases. We aim to continue improving trauma care provided through the center along with the Yokohama Medical Control Council and to overcome challenges that were identified through the peer review.

Is sex an independent risk factor of in-hospital mortality in patients with burns? A multicentre cohort study from urban India

IntroductionGlobally, nine million people are injured due to fire, heat and hot substances every year with a mortality rate of 1.34%. Research shows conflicting reports regarding sex as a risk factor for mortality in patient with burns. We analysed whether sex is a risk factor for in-hospital mortality in patients admitted with burns in urban India. MethodsA subgroup analysis of patients with burns as mechanism of injury was done from a multi-centre prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’ in India conducted in October 2013 to December 2015. Results1209 patients were identified as having suffered burnsfrom the TITCO study. The mean age was 23 years with 58.9% females. The overall 30 day in-hospital mortality was 574 (48.5%). Among patients who succumbed, 72% were females and 27% were males. We conducted a multivariable logistic regression and found that females were at a significantly higher odds of death compared with males (OR = 1.73 95%CI = 1.06–2.80, p value = 0.02). After performinga sex and age stratified analysis, females in the age group of 15–44 years had a significantly higher number of deaths compared to males in that group. ConclusionIn this multi-centerstudy from urban Indian university hospitals, sex was identified as an independent risk factor ofmortality in patients admitted with burns. Females have an increased odds of mortality from burns.

Comparing trauma mortality of injured patients in India and the USA: a risk-adjusted analysis

ObjectivesComparisons of risk-adjusted trauma mortality between high-income countries and low and middle-income countries (LMICs) can be used to identify specific patient populations and injury patterns for targeted interventions. Due to...

Nursing workload of trauma patients in the emergency room: A prospective cohort study

• Knowing the nursing workload is fundamental to improve trauma care in the emergency. • Measuring the nursing workload is essential to adequately dimension the trauma team. • Severely traumatized patients require a high workload in the emergency room. • Patient’s oxygenation , bleeding and temperature control increase nursing workload. • Intentional self-harm trauma increase the nursing workload.

Improving trauma care – A case study from Dodoma, Tanzania

AimThis article describes work done to support improvements to a trauma system in Dodoma, Tanzania. It was completed to augment a study-abroad program. BackgroundDodoma is in the center of Tanzania in East Africa and has, in recent years, been designated as a center of government. Formerly the commercial and political center was Dar es Salaam which became an overcrowded city that was rich in resources but often inaccessible for the majority of the citizens. This has impacted the once quiet community f Dodoma with a great influx of people. Commerce and the services that are needed to support development have led to massive growth with plans for a well thought-out infrastructure to support it. It has also brought challenges to the region. Preparing for this growth, hospital personnel needed to be prepared to meet the health needs of the population. Rutgers’ School of Nursing has embarked on a relationship with the region that has been beneficial to the Dodoma community as well as the Rutgers community. DesignThis is a descriptive analysis of work that has been done in collaboration with Rutgers University, School of Nursing, University of Dodoma and the Regional Hospital of Dodoma which has included faculty and students. MethodsAn analysis was completed of bi-lateral work that has been conducted over three years. ResultsSystems have been developed both clinically as well as educationally to increase knowledge of trauma care of patients. ConclusionBilateral relationships are important not only for the visiting students and faculty but also for the country that is being visited.

Utility of an orthopaedic trauma registry in Ghana.

None declared.

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study

BackgroundRenal trauma is present in 0.5–5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes.MethodsWe analysed “Towards Improved Trauma Care Outcomes in India” cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details.ResultsA total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic injuries were the most common mechanism (53%) followed by falls (29%). Most renal injuries (89%) were associated with other organ injuries. Seven of the 144 (5%) patients required nephrectomy. Three patients had grade V trauma; all underwent nephrectomy. The 30-day in-hospital mortality, in patients with renal trauma, was 17% (24/144).ConclusionMost renal trauma patients were managed nonoperatively. 89% of patients with renal trauma had concomitant injuries. The renal trauma profile from this large cohort may be generalisable to urban contexts in India and other low- and middle-income countries.

Improved documentation following the implementation of a trauma registry: A means of sustainability for trauma registries in low- and middle-income countries

Introduction: Trauma registries in low- and middle-income countries (LMICs) are critical for improving trauma care; however, while some registries have been established in low-income settings, few are sustained due to a lack of sustainable funding. In many LMIC institutions, funding is dependent on documentation of trauma patients, but patient records may be of poor quality, missing, or incomplete. The development of a trauma registry and electronic patient registration system could be used to improve documentation of trauma patients in a low-income setting and lead to increased funding for trauma care.Methods: A retrospective chart review of trauma patients at Mbarara Regional Referral Hospital in Uganda was performed, documenting the monthly admissions from January 2015-July 2016 prior to the establishment of a trauma registry. A trauma registry and electronic patient registration system were established in 2017, and monthly admissions from February 2017-December 2019 were documented. A negative binomial regression analysis was performed comparing the incident rate of admission pre-implementation of the registry compared to post-implementation, adjusting for month and year. Completeness of trauma patient records was also assessed.Results: Prior to the implementation of the trauma registry and patient registration system (2015-2016), there was a mean of 5.2 (SD 4.4) trauma records per month identified. Following the implementation of the trauma registry, a mean of 103.4 trauma records per month were documented (SD 32.0) for an increased incident rate ratio of 20.9 (95% CI 15.7-27.6, p<0.001). There was also a significant increase in percentage of documents completed (OR 49.1, CI 12.4-193.7, p<0.001).Discussion: Following the implementation of a trauma registry and electronic patient registration system at this low-income country hospital, an increase of 20.9 times completed trauma patient documentation was identified, and completion of the records improved. This more accurate documentation could be used to apply for increased government funding for trauma patients and sustain the trauma registry in the long term and could represent a means of long-term sustainability for other trauma registries in LMICs.

Identifying indicators and evaluation steps with suggestions for improving trauma care in Iran: experts’ perspective

:Background:Trauma is one of the major causes of mortality across the world. Trauma patients have critical status and need timely, adequate, and organized care. The different consequences of trauma care among service centers around the world and even within a country revealed the need for careful evaluation. This study was designed and executed to collect experts’ opinions on the evaluation steps, related indicators, and improvement strategies in trauma care.Methods:This qualitative study was based on a conventional content analysis approach. 2 focus group discussions (FGD) with 6 participants per FGD and 16 face-to-face in-depth interviews were conducted to collect the required information (from September 2018 to early 2019). Participants were selected through the purposive sampling method. The experts’ viewpoints were classified by the main and sub themes.Results:Four basic themes extracted from the interviews and focus group discussions including, trauma care importance (sub-themes: the involved individuals’ being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators, and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators before the evaluation, determining evaluation time scope, determining evaluation dimensions, external and internal evaluation and use of evaluation results); trauma care improvement (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers).Conclusions:According to experts’ viewpoints, trauma is a very important issue, because it involves young people. They believed that having indicators covering all aspects of care assist health managers and policymakers to understand under-standard performance. These indicators should be used in the form of a specific evaluation program and related to Iran context. Besides, reforming macro policies, planning, development of infrastructures, and education was some recommendations of experts to improve trauma care.

Incidence and Nature of Lower-Limb Deep Vein Thrombosis in Patients with Polytrauma on Thromboprophylaxis: A Prospective Cohort Study

PurposeDeep vein thrombosis (DVT) is common among the severely injured and may lead to pulmonary embolism (PE), which can be life threatening. Thromboprophylaxis may reduce the incidence of venous thromboembolism (VTE); it does not guarantee complete protection. This study’s primary aim was to determine the incidence and nature of lower-limb DVT in polytrauma patients taking prophylaxis. The secondary objective was to assess the incidence of DVT-related complications, including the development of PE and death.Patients and MethodsThis prospective observational study included patients age 18 years or older who presented with polytrauma directly from the scene and were admitted into the trauma unit between March 1, 2020 and August 31, 2020. All patients underwent lower-limb ultrasound during their hospital course to diagnose DVT.ResultsA total of 169 patients underwent extremity Doppler ultrasound to detect DVT. Of these, 69 patients (40.8%) were considered at the highest-risk for VTE development. For VTE prophylaxis, 115 patients (68%) received pharmacologic agents, and 54 patients (32%) had intermittent pneumatic compression on admission. Three patients (1.8%) developed DVT despite prophylaxis. Four patients (2.4%) developed PE during the index presentation and were diagnosed between days 3 and 13 after injury. Early DVT was not detected in any patients with diagnosed PE. Overall, nine patients (5.33%) died, but no in-hospital deaths were related to DVT and/or PE.ConclusionThe incidence of DVT in polytrauma patients remains low in our small series, perhaps because of the mandatory VTE risk assessment for all hospitalized patients and the early initiation of prophylaxis. Using a trauma center registry to measure DVT and PE incidence regularly is recommended to improve trauma care quality.

A Smartphone Application for Teamwork and Communication in Trauma: Pilot Evaluation "in the Wild".

To evaluate the potential for a smartphone application to improve trauma care through shared and timely access to patient and contextual information. Disruptions along the trauma pathway that arise from communication, coordination, and handoffs problems can delay progress through initial care, imaging diagnosis, and surgery to intensive care unit (ICU) disposition. Implementing carefully designed and evaluated information distribution and communication technologies may afford opportunities to improve clinical performance. This was a pilot evaluation "in the wild" using a before/after design, 3 month, and pre- post-intervention data collection. Use statistics, usability assessment, and direct observation of trauma care were used to evaluate the app. Ease of use and utility were assessed using the technology acceptance model (TAM) and system usability scale (SUS). Direct observation deployed measures of flow disruptions (defined as "deviations from the natural progression of an procedure"), teamwork scores (T-NOTECHS), and treatment times (total time in emergency department [ED]). The app was used in 367 (87%) traumas during the trial period. Usability was generally acceptable, with higher scores found by operating room (OR), ICU, and neuro and orthopedic users. Despite positive trends, no significant effects on flow disruptions, teamwork scores, or treatment times were observed. Pilot trials of a clinician-centered smartphone app to improve teamwork and communication demonstrate potential value for the safety and efficiency of trauma care delivery as well as benefits and challenges of "in-the-wild" evaluation.