Polytrauma Care Research Articles

Care for Seriously Injured People in Military Conflicts

The current war in Ukraine has drawn public attention to the treatment of war injuries. Follow-up treatment in Germany is portrayed the clover leaf of the TraumaNetzwerke DGU, is largely based on the demands of the Federal Ministries for Defence and Health and is intended to enhance resilience in war.The present article presents the special features of the care of severely injured patients during hostilities and should provide insights into the expected results of treatment and the actual procedures. We emphasise the unpredictability of the care of the severely injured during hostilities.On the basis of a search of the literature for the deployment of the German Army in Afghanistan and for the current war in Ukraine, we present the challenges and the typical patterns of injuries. We discuss the factors that can influence the procedures and the quality of the results during hostilities and how these may differ from civil polytrauma care in Germany - which is well established and standardised.Even during deployment of the Federal Army or (as planned) NATO, care of the severely injured is under standardised conditions, as based on the algorithmic ATLS care and which is concentrated on bleeding control. The corresponding equipment and personnel are well established, well prepared and well trained.However, there may be special local conditions or special deployments that make it inevitable that emergency medical care will be more delayed than in the civil system in Germany and can only take place after protracted transport. The objective is always that soldiers in combat should be able to receive medical care that is equivalent to that received by all accident victims in Germany, whatever the time and site of the accident.

Urologic Trauma Management for Military Providers.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Predicting the complexity and mortality of polytrauma patients with machine learning models

We aim to develop machine learning (ML) models for predicting the complexity and mortality of polytrauma patients using clinical features, including physician diagnoses and physiological data. We conducted a retrospective analysis of a cohort comprising 756 polytrauma patients admitted to the intensive care unit (ICU) at Pizhou People’s Hospital Trauma Center, Jiangsu, China between 2020 and 2022. Clinical parameters encompassed demographics, vital signs, laboratory values, clinical scores and physician diagnoses. The two primary outcomes considered were mortality and complexity. We developed ML models to predict polytrauma mortality or complexity using four ML algorithms, including Support Vector Machine (SVM), Random Forest (RF), Artificial Neural Network (ANN) and eXtreme Gradient Boosting (XGBoost). We assessed the models’ performance and compared the optimal ML model against three existing trauma evaluation scores, including Injury Severity Score (ISS), Trauma Index (TI) and Glasgow Coma Scale (GCS). In addition, we identified several important clinical predictors that made contributions to the prognostic models. The XGBoost-based polytrauma mortality prediction model demonstrated a predictive ability with an accuracy of 90% and an F-score of 88%, outperforming SVM, RF and ANN models. In comparison to conventional scoring systems, the XGBoost model had substantial improvements in predicting the mortality of polytrauma patients. External validation yielded strong stability and generalization with an accuracy of up to 91% and an AUC of 82%. To predict polytrauma complexity, the XGBoost model maintained its performance over other models and scoring systems with good calibration and discrimination abilities. Feature importance analysis highlighted several clinical predictors of polytrauma complexity and mortality, such as Intracranial hematoma (ICH). Leveraging ML algorithms in polytrauma care can enhance the prognostic estimation of polytrauma patients. This approach may have potential value in the management of polytrauma patients.

Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center.

Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0-5 years; Group B: 6-10 years; Group C: 11-15 years; and Group D: 16-18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0-5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population.

Advancing polytrauma care: developing and validating machine learning models for early mortality prediction

BackgroundRapid identification of high-risk polytrauma patients is crucial for early intervention and improved outcomes. This study aimed to develop and validate machine learning models for predicting 72 h mortality in adult polytrauma patients using readily available clinical parameters.MethodsA retrospective analysis was conducted on polytrauma patients from the Dryad database and our institution. Missing values pertinent to eligible individuals within the Dryad database were compensated for through the k-nearest neighbor algorithm, subsequently randomizing them into training and internal validation factions on a 7:3 ratio. The patients of our institution functioned as external validation cohorts. The predictive efficacy of random forest (RF), neural network, and XGBoost models was assessed through an exhaustive suite of performance indicators. The SHapley Additive exPlanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) methods were engaged to explain the supreme-performing model. Conclusively, restricted cubic spline analysis and multivariate logistic regression were employed as sensitivity analyses to verify the robustness of the findings.ResultsParameters including age, body mass index, Glasgow Coma Scale, Injury Severity Score, pH, base excess, and lactate emerged as pivotal predictors of 72 h mortality. The RF model exhibited unparalleled performance, boasting an area under the receiver operating characteristic curve (AUROC) of 0.87 (95% confidence interval [CI] 0.84–0.89), an area under the precision-recall curve (AUPRC) of 0.67 (95% CI 0.61–0.73), and an accuracy of 0.83 (95% CI 0.81–0.86) in the internal validation cohort, paralleled by an AUROC of 0.98 (95% CI 0.97–0.99), an AUPRC of 0.88 (95% CI 0.83–0.93), and an accuracy of 0.97 (95% CI 0.96–0.98) in the external validation cohort. It provided the highest net benefit in the decision curve analysis in relation to the other models. The outcomes of the sensitivity examinations were congruent with those inferred from SHAP and LIME.ConclusionsThe RF model exhibited the best performance in predicting 72 h mortality in adult polytrauma patients and has the potential to aid clinicians in identifying high-risk patients and guiding clinical decision-making.

Erratum to: Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers

Erratum to: Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers

Putting the trauma back into trauma and orthopaedics: TIG fellowships

How TIG fellowships can prepare you with the skills and abilities required for polytrauma care.

Surgical load in major fractures — results of a survey on the optimal quantification and timing of surgery in polytraumatized patients

PurposeIt is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions.MethodsA standardized questionnaire was developed by experts from Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between “1,” defined as the surgical load equivalent to external (monolateral) fixator application, and “5,” defined as the maximal surgical load possible in that specific anatomic region.ResultsThis questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as well as fractures in distal anatomic regions, such as hands, ankles, and feet, were consistently ranked lower in their surgical load.ConclusionThis study demonstrates a consensus in the trauma community about the crucial relevance of the surgical load in polytrauma care. The surgical load is ranked higher with increased intraoperative bleeding and greater soft tissue damage/extent of surgical approach and depends relevantly on the anatomic region and kind of operative procedure. The experts especially consider anatomic regions and the risk of intraoperative bleeding as well as fracture complexity to guide staging protocols. Specialized guidance and teaching is required to assess both the patient’s physiological status and the estimated surgical load reliably in the preoperative decision-making and operative staging.

Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers

Changes in patient care occurred as aresult of the SARS-CoV‑2 virus, and both intrahospital and prehospital care were profoundly affected. Public shutdowns during lockdown periods were intended to prevent overstretching existing resources, resulting in noticeable changes in medical care for both elective treatments and emergency medicine. This study now considered the impact of the COVID19 pandemic on air ambulance services at acentral air ambulance site in 2020 compared to the previous 2years. Aretrospective evaluation of all missions of the rescue helicopter Christoph9 in the first COVID-19 pandemic year 2020 in comparison to the years 2018 and 2019 was performed. The mission logs were evaluated for the analysis. There was a20% reduction in the number of missions in 2020, with primarily internal medicine missions affected. Despite the lockdown periods and reduction in social life, the proportion of trauma deployments remained nearly the same. As expected, the proportion of occupational accidents decreased, and recreational activities resulted in accidents more frequently. Injury or illness severity showed no significant differences. In terms of internal diseases, there was areduction in alerts for acute coronary syndrome and respiratory emergencies. The proportion of suicide-related injuries remained constant over the years. During the COVID-19study period, adecrease in the number of deployments and aborted deployments was observed. However, no significant differences in deployment and injury characteristics were observed for trauma-related deployments. These results highlight the importance of air ambulance services to ensure patient care even during pandemic periods.

Quality Indicators of pediatric polytrauma care

Quality Indicators of pediatric polytrauma care

CONSIDERATIONS ON POLYTRAUMATISM IN THE YOUNG ADULT

Trauma continues to be a major problem in the young, working-age population, so many societies have tried to improve polytrauma care methods. Over the last two decades, various systems have been published to facilitate the identification of treatment strategies for patients with multiple trauma. Safe and prompt individualized management (Prompt individualized safe management (PRISM)) is a new concept that includes the approach of each patient separately.The main objectives of this study were to highlight the socio-demographic characteristics, clinical and paraclinical characteristics, and various risk factors of young adults with polytrauma. The study presented in this article was of a descriptive, retrospective type, including 1294 patients who presented themselves in the Emercency-department of the " Saint Andrei" County Emergency Hospital, Galaţi.The data obtained from the statistical reports of the hospital and the presentation sheets of the patients, have been statistically analyzed using SPSS and MS Excell. There for, we have been able to analyze and to obtain statistically relevant results for the distribution of polytrauma cases, seasonality and evolution aspects regarding the toracoabdominal traumas (87.5%) and craniofacial traumas (76.8%), which have been the most frequent forms.

Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients.

There has been an ongoing discussion as to which interventions should be carried out by an “organ specialist” (for example, a thoracic or visceral surgeon) or by a trauma surgeon with appropriate general surgical training in polytrauma patients. However, there are only limited data about which exact emergency interventions are immediately carried out. This retrospective data analysis of one Level 1 trauma center includes adult polytrauma patients, as defined according to the Berlin definition. The primary outcome was the four most common emergency surgical interventions (ESI) performed during primary resuscitation. Out of 1116 patients, 751 (67.3%) patients (male gender, 530, 74.3%) met the inclusion criteria. The median age was 39 years (IQR: 25, 58) and the median injury severity score (ISS) was 38 (IQR: 29, 45). In total, 711 (94.7%) patients had at least one ESI. The four most common ESI were the insertion of a chest tube (48%), emergency laparotomy (26.3%), external fixation (23.5%), and the insertion of an intracranial pressure probe (ICP) (19.3%). The initial emergency treatment of polytrauma patients include a limited spectrum of potential life-saving interventions across distinct body regions. Polytrauma care would benefit from the 24/7 availability of a trauma team able to perform basic potentially life-saving surgical interventions, including chest tube insertion, emergency laparotomy, placing external fixators, and ICP insertion.

Is polytrauma treatment in deficit in the aG-DRG system?

HintergrundDie interdisziplinäre Versorgung von polytraumatisierten PatientInnen ist personal- und ressourcenaufwendig. Seit der Einführung des G‑DRG-Systems 2003 in Deutschland wurde in den meisten Untersuchungen ein finanzielles Defizit in der Schwerstverletztenversorgung festgestellt. Ziel dieser Studie war es, Auswirkungen des 2020 neu eingeführten aG-DRG-Systems auf die Kostendeckung in der Schwerverletztenbehandlung zu analysieren. Erstmals wurden auch die Kosten für Organisation, Zertifizierung und Dokumentation sowie die Kosten für nicht schwer verletzte SchockraumpatientInnen betrachtet.MethodikEingeschlossen wurden alle PatientInnen, die im Jahr 2017 im chirurgischen Schockraum der Zentralen Notaufnahme des Universitätsklinikums Leipzig behandelt wurden. Für die Analyse wurden das Kostenmodell nach Pape et al. um die Module Organisation, Dokumentation und Zertifizierung ergänzt sowie die Kosten für „übertriagierte“ PatientInnen betrachtet. Es erfolgte die Berechnung der Kosten in den Jahren 2017–2020 im Vergleich der jeweiligen Erlöse.ErgebnisseEs wurden 834 PatientInnen im Schockraum behandelt. Die 258 schwer verletzten PatientInnen wurden in 3 Gruppen untergliedert: „ISS 9–15 + ITS“ (n 72; ∅ ISS 11,9; Kosten/PatientIn 14.715 €), „ISS ≥ 16“ (n 186; ∅ ISS 27,7; Kosten/PatientIn 30.718 €) und „DRG-Polytrauma“ (n 59; ∅ ISS 32,4; Kosten/PatientIn 26.102 €).SchlussfolgerungDie Polytraumaversorgung im aG-DRG 2020 ist defizitär. Insgesamt entstand im Jahr 2020 ein Defizit von 5858 € pro schwer verletztem/verletzter PatientIn.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00113-021-01015-5) enthält zusätzliche Tabellen zur Kostenberechnung sowie detaillierte Informationen zur Methode, weitere Ergebnisse und weiterführende Literatur. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Falls from Great Heights: Risk to Sustain Severe Thoracic and Pelvic Injuries Increases with Height of the Fall.

Falls from a height are a common cause of polytrauma care in Level I Trauma Centers worldwide. The expected injury consequences depend on the height of the fall and the associated acceleration, as well as the condition of the ground. In addition, we further hypothesize a correlation between the cause of the fall, the age of the patient, and the patient’s outcome. A total of 178 trauma patients without age restriction who were treated in our hospital after a fall >3 m within a 5-year period were retrospectively analyzed. The primary objective was a clinically and radiologically quantifiable increase in the severity of injuries after falls from different relevant heights (>3 m, >6 m, and >9 m). The cause of the fall, either accidental or suicidal; age and duration of intensive care unit stay, including duration of ventilation; and total hospital stay were analyzed. Additionally, the frequency of urgent operations, such as, external fixation of fractures or hemi-craniectomies, laboratory parameters; and clinical outcomes were also among the secondary objectives. Sustaining a thoracic trauma or pelvis fractures increases significantly with height, and vital parameters are significantly compromised. We also found significant differences in urgent pre- and in-hospital emergency interventions, as well as organ complications and outcome parameters depending on the fall’s height.

Impact of Nursing Intervention Protocol about Polytrauma Care during the Golden Hour on Nurses’ Performance

Background: The golden hour following a traumatic event is characterized by the need for rapid assessment and immediate resuscitation treatment, which represent the fundamental principles of Advanced Trauma Life Support. Aim: This study aimed to assess the impact of nursing intervention protocol about polytrauma care during the golden hour on nurses‟ performance. Research hypothesis: This study was hypothesized that the nurses‟ knowledge and practice will be significantly improved after implementing nursing intervention protocol. Research Design: A quasi-experimental design study with one group pre-test post-test approach was used to achieve the aim of the present study. Setting: it was conducted at Emergency departments affiliated to Ain Shams university hospitals. Subjects: A Convenient sample of all available nurses (thirty) working in Emergency departments. Tools: I- Self-administered nurses‟ polytrauma care knowledge questionnaire, it was used to assess nurses‟ knowledge regarding management of patient with polytrauma during the golden hour and II- Nurses‟ polytrauma care practice observational checklist: to assess nurses‟ practice regarding management of patients with polytrauma during the golden hours. Results: it was found that two thirds of the nurses were between twenty five to forty years, and less than half of them were graduated from nursing institute. There were highly statistically significant differences in knowledge and practice regarding care of patients with polytrauma during the golden hour with marked improvement post implementation among studied nurses. There was a significant relation between studied nurses' knowledge & practice and gender & education. Conclusion: there was an improvement in knowledge and practice post nursing intervention protocol implementation among studied nurses with statistically significant differences between pre- and post- knowledge, and practice. Recommendations: Replication of the study on a large probability sample for results generalization and Improve and update nurses‟ knowledge and skills about management of patients with polytrauma during the golden hour.

High acuity polytrauma centers in orthopaedic trauma: Decreasing patient mortality with effective resource utilization

BackgroundThere is a select number of massive-volume, high-acuity trauma centers (HACs) in the United States. Expertise in polytrauma care has been associated with improved mortality in general surgery trauma, though has not been investigated in orthopaedic trauma. With complex polytrauma proficiency comes the inherent risk of intensive care, complications, and prolonged inpatient stays, without a commensurate increase in allocated resources. The purpose of this study was to compare mortality, complications, and length of stay in polytraumatized orthopaedic patients treated at HACs vs. low-acuity trauma centers (LACs). MethodsThe National Trauma Data Bank was queried for orthopaedic injuries with injury severity score (ISS)>15 and mortality, complications, hospital length of stay, ICU length of stay, ventilation duration, and demographics. Hospitals where at least 13% (median percentage of patients with ISS > 15 admitted to all hospitals) of total admissions had an ISS>15 were classified as HAC; all others were LACs. ResultsHACs admitted 86.8% of 28,314 patients with ISS>15. On univariate analysis, patients at HACs have 16% decreased odds of in-hospital mortality vs. LACs (p=0.005); the effect increased to 27% (p=0.002) on multivariate analysis. Patients at HACs have 63% greater odds of ICU admission (p<0.001), 48% higher odds of ventilatory support (p=<0.001), 38% increased odds of unplanned reoperation (p=0.007), and 37% increased odds of medical complications (p<0.001). On multivariate analysis, secondary outcome measures showed no significant difference between HACs and LACs. Patients at HACs had 2.8 days longer length-of-stay (p<0.001). ConclusionSeverely injured orthopaedic trauma patients have decreased mortality at HACs, despite having a higher average ISS and a higher prevalence of obesity and active smoking. While there is a higher incidence of ICU admission, mechanical ventilation, complications, and unplanned reoperation on univariate analysis, correction for ISS and patient factors enhances the effect of HACs on mortality, but removes the effect on secondary measures. Thus, HACs are life-saving institutions for polytraumatized orthopaedic patients, and the known resource demand of these hospitals is supported by their favorable outcome profile. Level of evidenceIV

Surgical management of spine injuries in severe polytrauma patients: a retrospective study

Background: Optimal surgical management of spinal injuries as part of life-threatening multiple traumas remains challenging. We provide insights into the surgical management of spinal injuries in polytrauma patients. Methods: All patients from our polytrauma care network who both met at least one positive Vittel criteria and an injury severity score (ISS) >15 at admission and who underwent surgery for a spinal injury were included retrospectively. Demographic data, clinical data demonstrating the severity of the trauma and imaging defining the spinal and extraspinal number and types of injuries were collected.Results: Between January 2012 and December 2016, 302 (22.2%) patients suffered from spinal injury (143 total injuries) and 83 (6.1%) met the inclusion criteria. Mean ISS was 36.2 (16–75). Only 48 (33.6%) injuries led to neurological impairment involving the thoracic (n = 23, 16.1%) and lower cervical (n = 15, 10.5%) spine. The most frequent association of injuries involved the thoracic spine (n = 42). 106 spinal surgeries were performed. The 3-month mortality rate was 2.4%.Conclusions: We present data collected on admission and in the early postoperative period referring to injury severity, the priority of injuries, and development of multi-organ failure. We revealed trends to guide the surgical support of spinal lesions in polytrauma patients.

Latin America trauma systems-Mexico and Brazil.

In this brief review, the authors describe the main characteristics of trauma systems in Latin America's 2 most populous countries, Mexico and Brazil. Trauma is a common health problem and the major cause of death in the young populations in both countries. Mexico and Brazil have well-organized systems based on system designation and prehospital triage. The highest level trauma hospitals are only available in the biggest cities, with residents of the smaller cities having less access to quality care. Both countries can provide adequate musculoskeletal trauma and polytrauma care, but the systems are not universally equal and, therefore, not ideal. The lack of consistency and standardization of the systems across each country must be addressed to improve patient outcomes across each country.

Barriers and strategies for coordinating care among veterans with traumatic brain injury: a mixed methods study of VA polytrauma care team members

ABSTRACTBackground: Veterans who experience traumatic brain injury (TBI) may have long-term needs placing a premium on well-coordinated care. This study aimed to (1) identify barriers to care coordination for Veterans with TBI; and (2) describe strategies used by VA polytrauma care team members to coordinate care for Veterans with TBI.Methods: We utilised a mixed method design, including an online survey of VA polytrauma care team members (N = 236) and subsequent semi-structured interviews (N = 25). Analysis of the survey data was descriptive; interview data was analysed using constant comparative techniques.Results: The most common system-related barriers 25 for access to military records (64%) and insufficient time (58%). The most common patient-related barriers were missed appointments/no shows (87%) and the mental health issues (74%). Strategies reported on the survey to promote coordination reflected the centrality of teamwork and communication, and included promoting multidisciplinary team collaboration (32%) and holding 30 regular meetings (23%). Interview findings were consistent, emphasising the effective functioning of multidisciplinary clinics.Conclusion: Polytrauma care team members encounter barriers to care coordination for Veterans with TBI, and have developed strategies in response. Information sharing, provider workload, communication, and patient engagement will be critical to address in future efforts to enhance care coordination in this context.

Clinical information seeking in traumatic brain injury: a survey of Veterans Health Administration polytrauma care team members.

The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult. To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information. Cross-sectional online survey of 236 VHA polytrauma care team members. Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers. Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform. Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit-pronged approach to time and financial constraints.