Prehospital Assessment Research Articles

Pre-hospital assessment for Primary Angioplasty (PAPA) reduces reperfusion times in ST Elevation Myocardial Infarction (STEMI) - A report from the Hunter New England Local Health District

sheaths can cause access-site complications. We aim to examine these complications. Methods:Data in 210 patients undergoing TAVR 2008-2014 were examined for peripheral access-site vascular complication (PVAC) using Valve Academic Research Consortium (VARC) 2 criteria. Results: Seventeen (8.1%) patients suffered a PVAC (13 major, 4 minor). Of the 17 patients, 2 (11.7%) required thrombin injection, 4 (23.5%) required surgical intervention, 5 (29.4%) required stent implantation and 1 (5.9%) required angioplasty. Five (29.4%) patients were managed conservatively. Comparing thosewith andwithout PVAC, thereweremore females (76.5% vs. 49.7%, p 2 (11.8%vs. 13.5%) p≥0.28. Of the 6 patients treated percutaneously, 1 died 7 days postprocedure from neurological complications and 1 patient had an intentional occlusion of their superficial femoral artery but no associated morbidity. All other patients made a full recovery with no medium-term sequelae. Conclusion: TAVR peripheral vascular access complications are infrequent and most subjects make a full recovery. Importantly, peripheral stenting alone has not caused any medium-term morbidity in patients. Further research into this area is needed to evaluate benefits of stenting over surgical repair for peripheral vascular complications of TAVR.

Chapter 23 - The prehospital management of traumatic brain injury

Traumatic brain injury (TBI) is an important cause of death and disability, particularly in younger populations. The prehospital evaluation and management of TBI is a vital link between insult and definitive care and can have dramatic implications for subsequent morbidity. Following a TBI the brain is at high risk for further ischemic injury, with prehospital interventions targeted at reducing this secondary injury while optimizing cerebral physiology. In the following chapter we discuss the prehospital assessment and management of the brain-injured patient. The initial evaluation and physical examination are discussed with a focus on interpretation of specific physical examination findings and interpretation of vital signs. We evaluate patient management strategies including indications for advanced airway management, oxygenation, ventilation, and fluid resuscitation, as well as prehospital strategies for the management of suspected or impending cerebral herniation including hyperventilation and brain-directed hyperosmolar therapy. Transport decisions including the role of triage models and trauma centers are discussed. Finally, future directions in the prehospital management of traumatic brain injury are explored.

Accuracy of the pre-hospital assessment for primary Angioplasty (PAPA) program in the Illawarra region of NSW

Accuracy of the pre-hospital assessment for primary Angioplasty (PAPA) program in the Illawarra region of NSW

Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort

ObjectiveFirst, to determine the sensitivity and specificity of six stroke recognition scores in a single cohort to improve interscore comparability. Second, to test four stroke severity scores repurposed to recognise...

A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward--a pilot study on ambulance nurses and Emergency Department physicians.

A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward − a pilot study on ambulance nurses and Emergency Department physicians.BackgroundPatients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED.MethodsThe pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N = 51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N = 51) received traditional care at the ED. All p-values are age-adjusted.ResultsPatients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p = 0.02). The median delay from arrival at the patient’s side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p < 0.0001). However, the median delay time from the ambulance’s arrival at the patient’s side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p < 0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p = 0.16).ConclusionThe pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.

Abstract 343: Prediction of Lifesaving Interventions Using Changes in Vital Signs from Prehospital Scene to Emergency Department

Objective: We investigate whether changes in vital signs between the prehospital scene and emergency department (ED) can be used to develop triage tools to predict the need for life-saving interventions (LSI) and survival in trauma patients. Methods: We analyzed a prospective cohort with any prehospital systolic blood pressure (SBP) ≤ 90 mmHg or Glasgow Coma Scale ≤ 8 who were admitted to an ED at 11 sites of the Resuscitation Outcomes Consortium. The primary outcome was the need for in-hospital LSI (e.g. invasive airway management, invasive bleeding control, blood transfusion, craniotomy, cardiopulmonary resuscitation). Secondary outcome was survival to hospital discharge. Changes in heart rate (HR), SBP, shock index (SI), and respiratory rate (RR) from first prehospital assessment to first ED assessment were considered as predictors in addition to sex, age, mechanism of injury, trauma center level, duration of transport, type of transport, and prehospital fluid volume. Decision trees for each outcome were developed using binary recursive partitioning with predictive performance measured using sensitivity, specificity, and classification error. Results: 5625 subjects were included in our analysis with 49% in need of LSI and 21% dying prior to discharge. Patients needing an LSI tended to either: (1) have an increasing SI (delta ≥ 0.22), (2) have a decreasing SI (delta &lt; 0.22) and &gt;500 mL prehospital fluids, or (3) have a decreasing SI (delta &lt; 0.22), ≤500 mL prehospital fluids, and large change in RR (delta ≥ 9.5 or delta &lt; -7.5). Those surviving to discharge tended to either: (1) have a decreasing SI (delta &lt; 0.57) and a HR that did not decrease greatly (delta &gt; -47) or (2) have an increase in SI (0.57 ≤ delta &lt; 1) and a declining RR (delta &lt; 5). LSI tree had a sensitivity of 58.7% and specificity of 63.3%. Survival tree had sensitivity of 96.2% and specificity of 21.3%. Conclusion: Though the decision trees were constructed with the best data in terms of initial triage and early secondary triage, the classification performance was limited. This highlights the difficulties of developing vital sign based triage tools to predict the need for LSI and survival.

CURRENT TENDENCIES OF ACUTE CORONARY SYNDROME IN YOUNG WOMEN IN URBAN NORTH CONDITIONS (EVIDENCE FROM ARKHANGELSK)

The results of a cross-sectional study of 224 patients, Arkhangelsk residents, with the acute coronary syndrome (ACS) have been presented. Features of the disease course, approaches to treatment and complications in the women with ACS under the age of 55 compared with the men have been analyzed. It has been determined that the women under the age of 55 with ACS both with elevated ST- segment and without ST elevation were admitted to hospitals much later. This was caused by inadequate prehospital assessment of the clinical picture and frequent ACS atypical manifestations. In the hospital period, the women showed greater incidence of complications as bleeding (hematoma after lumbar puncture) and acute decompensated heart failure (ADHF) (pulmonary congestion, pulmonary edema) compared to the men.

Pre-hospital assessment and treatment of meningococcal meningitis

This article highlights ambiguities in current UK ambulance clinical guidelines for meningococcal meningitis and presents a discussion of the difficulty of diagnosing and treating the condition within a pre-hospital context. It recommends the development of a meningitis diagnostics scale in order to aid ambulance clinicians with a thorough patient assessment and to determine when treatment should be initiated. It suggests additionally that there should be further research into the benefits or detrimental effects of pre-hospital antibiotic treatment and adjunctive treatments, and whether non-penicillin antibiotics should start to be considered as the primary course of treatment for the UK ambulance service in relation to a world-wide increase in penicillin-resistant strains of meningococcal meningitis.

Abdominal injuries in a low trauma volume hospital--a descriptive study from northern Sweden.

BackgroundAbdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.MethodsThis retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.ResultsThe median New Injury Severity Score was 9 (range: 1–57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT < 60 min after emergency room arrival. Penetrating trauma caused injuries in seven patients. Solid organ injuries constituted 78% of abdominal injuries. Non-operative management succeeded in 82 patients. Surgery was performed for 28 patients, either immediately (n = 17) as result of operative management or later (n = 11), due to non-operative management failure; the latter mainly occurred with hollow viscus injuries. Patients with multiple abdominal injuries, whether associated with multiple trauma or an isolated abdominal trauma, had significantly more non-operative failures than patients with a single abdominal injury. One death occurred within 30 days.ConclusionsNon-operative management of patients with abdominal injuries, except for hollow viscus injuries, was highly successful in our low trauma volume hospital, even though surgeons receive low exposure to these patients. However, a growing proportion of surgeons lack experience in decision-making and performing trauma laparotomies. Quality assurance programmes must be emphasized to ensure future competence and quality of trauma care at low trauma volume hospitals.

The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study.

BackgroundErrors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional “scoop and run” practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).MethodsIn this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.ResultsIn this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.ConclusionsThe use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

Outcome of Trauma Patients Immobilized by Emergency Department Staff, but Not by Emergency Medical Services Providers: A Quality Assurance Initiative

Background. Prehospital selective cervical spine immobilization (CSI) is a relatively new concept. In our emergency medical services (EMS) system, protocols for selective CSI are widely used; yet, some patients who are brought to the hospital without CSI undergo secondary immobilization and cervical spine imaging in the emergency department (ED). Immobilization in the ED, after a decision not to immobilize by EMS, suggests that either the prehospital assessment is not trusted or the patient has developed new symptoms over time. We undertook a quality assurance initiative to evaluate whether trauma patients brought to the ED without CSI, who then underwent secondary CSI and imaging in the ED, had injuries that were initially missed by EMS selective CSI protocol. Methods. This was a 36-month retrospective data analysis of blunt trauma patients transported directly from the field to the University of New Mexico Hospital level I trauma center by Albuquerque Ambulance Service (AAS) between March 2009 and February 2012. Inclusion criteria were age 18 years and older, transported by AAS without CSI, and cervical spinal imaging done in the ED. Patients were excluded if they were being transported between facilities, were prisoners, and/or refused CSI. A positive finding was defined as any acute abnormality identified by the attending radiologist on the final imaging report. Results. The study included 101 patients who met inclusion criteria. There were no significant missed injuries. Ninety-four of the 101 patients received cervical spinal CT imaging at an estimated cost of $1,570 per scan, not including physician charges. The remaining patients had plain film radiographic imaging. No patients had magnetic resonance imaging. Conclusions. In this retrospective quality assurance initiative, none of 101 patients who underwent secondary CSI and imaging in the ED had a missed acute cervical injury. No patients had any adverse effects or required treatment, yet these patients incurred substantial costs and increased radiation exposure. While our results suggest hospital personnel should have confidence in prehospital decisions regarding CSI, continued surveillance and a large-scale, prospective study are needed to confirm our findings.

Prehospital stroke scales in urban environments: a systematic review.

To identify and compare the operating characteristics of existing prehospital stroke scales to predict true strokes in the hospital. We searched MEDLINE, EMBASE, and CINAHL databases for articles that evaluated the performance of prehospital stroke scales. Quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We abstracted the operating characteristics of published prehospital stroke scales and compared them statistically and graphically. We retrieved 254 articles from MEDLINE, 66 articles from EMBASE, and 32 articles from CINAHL Plus database. Of these, 8 studies met all our inclusion criteria, and they studied Cincinnati Pre-Hospital Stroke Scale (CPSS), Los Angeles Pre-Hospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Medic Prehospital Assessment for Code Stroke (Med PACS), Ontario Prehospital Stroke Screening Tool (OPSS), Recognition of Stroke in the Emergency Room (ROSIER), and Face Arm Speech Test (FAST). Although the point estimates for LAPSS accuracy were better than CPSS, they had overlapping confidence intervals on the symmetric summary receiver operating characteristic curve. OPSS performed similar to LAPSS whereas MASS, Med PACS, ROSIER, and FAST had less favorable overall operating characteristics. Prehospital stroke scales varied in their accuracy and missed up to 30% of acute strokes in the field. Inconsistencies in performance may be due to sample size disparity, variability in stroke scale training, and divergent provider educational standards. Although LAPSS performed more consistently, visual comparison of graphical analysis revealed that LAPSS and CPSS had similar diagnostic capabilities.

Notärztliche Einschätzung der klinischen Weiterversorgung von Notfallpatienten

Prehospital assessment of illness and injury severity with the National Advisory Committee for Aeronautics (NACA) score and hospital pre-arrival notification of a patient who is likely to need intensive care unit (ICU) or intermediate care unit (IMC) admission are both common in Germany's physician-staffed emergency medical services (EMS) system. This study aimed at comparing the prehospital evaluation of severity of disease or injuries by EMS physicians and the subsequent clinical treatment in unselected emergency department (ED) patients. This study involved a prospective observational analysis of patients transported to the ED of an academic level I hospital escorted by an EMS physician over a period of 6 months (February-July 2011). The physician's qualification and the patient's NACA score were documented and the EMS physician was asked to predict whether the patient would need hospital admission and, if so, to the general ward, IMC or ICU. After the ED treatment, discharge or admission, outcome and length of hospital and ICU or IMC stay were documented. A total of 378 mostly non-trauma patients (88 %) treated by experienced EMS physicians could be enrolled. The number of patients discharged from the ED decreased, while the number of patients admitted to the ICU increased with higher NACA scores. Prehospital prediction of discharge or admission, IMC or ICU treatment by EMS physicians was accurate in 47 % of the patients. In 40 % of patients a lower level of care was sufficient while 12 % needed treatment on a higher level of care than that predicted by EMS physicians. Of the patients 39 % who were predicted to be discharged after ED treatment, were admitted to hospital and 48 % of patients predicted to be admitted to the IMC were admitted to the general ward. Patients predicted to be admitted to the ICU were admitted to the ICU in 75 %. Higher NACA scores were associated with increased mortality and a longer hospital IMC or ICU length of stay, but significant differences were only found between patients with NACA V versus VI scores or patients predicted to be treated on the IMC versus the ICU. Prehospital NACA scores indicate the need for inpatient treatment, but neither hospital discharge or admission nor need of IMC or ICU admission after initial ED treatment could be sufficiently predicted by EMS physicians. Thus, hospital prenotification in order to predispose IMC or ICU capacities does not seem to be useful in cases where an ED can reassess admitted EMS patients.

PW152 Initial Experience With The Pre-Hospital Assessment For Primary Angiogram (PAPA) Program For ST Elevation Myocardial Infarction Based On The Glasgow Algorithm At A Regional New South Wales Hospital Without Onsite Cardiac Surgery

PW152 Initial Experience With The Pre-Hospital Assessment For Primary Angiogram (PAPA) Program For ST Elevation Myocardial Infarction Based On The Glasgow Algorithm At A Regional New South Wales Hospital Without Onsite Cardiac Surgery

PM210 Comparing Outcomes of Primary Percutaneous Coronary Interventions For ST Elevation Myocardial Infarcts Assessed Via The Pre-Hospital Assessment For Primary Angiogram (PAPA) Program and In The Emergency Department At A Regional New South Wales Hospital Without Onsite Cardiac Surgery

PM210 Comparing Outcomes of Primary Percutaneous Coronary Interventions For ST Elevation Myocardial Infarcts Assessed Via The Pre-Hospital Assessment For Primary Angiogram (PAPA) Program and In The Emergency Department At A Regional New South Wales Hospital Without Onsite Cardiac Surgery

Spinal Motion Restriction: An Educational and Implementation Program to Redefine Prehospital Spinal Assessment and Care

Introduction. Prehospital spine immobilization has long been applied to victims of trauma in the United States and up to 5 million patients per year are immobilized mostly with a cervical collar and a backboard. Objective. The training of paramedics and emergency medical technicians on the principals of spine motion restriction (SMR) will decrease the use of backboards. Methods. The training for SMR emphasized the need to immobilize those patients with a significant potential for an unstable cervical spine fracture and to use alternative methods of maintaining spine precautions for those with lower risk. The training addressed the potential complications of the use of the unpadded backboard and education was provided about the mechanics of spine injuries. Emergency medical services (EMS} personnel were taught to differentiate between the critical multisystem trauma patients from the more common moderate, low kinetic energy trauma patients. A comprehensive education and outreach program that included all of the EMS providers (fire and private), hospitals, and EMS educational institutions was developed. Results. Within 4 months of the policy implementation, prehospital care practitioners reduced the use of the backboard by 58%. This was accomplished by a decrease in the number of patients considered for SMR with low kinetic energy and the use of other methods, such as the cervical collar only. Conclusion. The implementation of a SMR training program significantly decreases the use of backboards and allows alternative methods of maintaining spine precautions. Keywords: Emergency Medical Services; humans; spinal injuries/therapy; transportation of patients; cervical vertebrae/injuries; emergency medical services/ methods; emergency medical technicians; immobilization/ methods; spinal motion restriction

Abstract W P312: Pre-Hospital and Hospital Data Linkage in an Organized Stroke System of Care: A Pilot Study

Objective: Quality improvement within organized stroke systems of care, where policies such as diversion to primary stroke centers (PSC) integrate pre-hospital strategies with hospital performance and patient outcomes, are dependent on accurate linkage of emergency medical services (EMS) and hospital patient data. Currently, such linkage is difficult due to patient privacy concerns, heterogeneous and discrete databases, and variability in data collection. The objective of this pilot project was to create and validate a linkage algorithm for EMS and hospital data from 2 primary stroke centers (PSC) in Chicago. Methods: A retrospective analysis of the Get With The Guidelines (GWTG) Stroke registry identified confirmed stroke patients treated at 2 regional PSCs during the first 2 months of 2013. Data from the EMS SafetyPAD database on all patients arriving to those 2 PSCs during the same period were also retrieved. These datasets were provided in CSV format without patient identifiers and inserted it into the Oracle Database for schema matching. We then used a deterministic matching process using 4 non-identifying variables (destination hospital, arrival date/time, age, and gender) in both pre-hospital (EMS) and hospital (GWTG) datasets to create an algorithm for probabilistic matching. A time difference of 30 minutes was used for arrival time to allow for the human error in the time documentation. The algorithm was first evaluated at PSC 1 then validated against data from PSC 2. Results: At PSC 1, there were 13 EMS arriving stroke patients during the study period. Of these, 11 were matched (84.6%) to EMS records using the deterministic matching algorithm. At PSC 2, there were 7 EMS arriving stroke patients during the same period, of which 5 (71.4%) were matched to EMS records. The overall matching rate was 80%. In the 4 non-matches, inaccurate date/time entry occurred. Conclusions: Implementing a pre-hospital to hospital data linkage system is feasible using 4 commonly included non-identifying data elements. Quality improvement initiatives such as decreasing scene-to-hospital time and assessing pre-hospital stroke assessment tools would be greatly facilitated by having these databases linked.

A clinical audit of the pre-hospital paediatric respiratory assessment in London

Assessing a child with difficulty in breathing is a challenge in a pre-hospital setting, especially children under 3 years old. Nevertheless, hypoxia must be treated early, and a respiratory assessment is essential to ensuring the well being of these patients. The aim of this audit was to update the research, as there have been changes in equipment and training since this was last addressed. A criterion-based clinical audit was undertaken of 253 patient report forms collected from the London Ambulance Service over a one-month period. The pre-hospital clinician must have coded dyspnoea (difficulty in breathing) and the patient's age must be under three years. The observations audited were: respiratory rate, auscultation attempt and oxygen saturations, any exceptions were noted. The results showed that 85% (n=220) had two respiratory rates recorded, 70% (n = 178) recorded an auscultation attempt, whilst two oxygen saturation recordings were documented for 52% (n=131). The main reason for no oxygen saturations was ‘no kit’, accounting for 38% (n= 45) of the non-compliance. Overall, 39% (n=99) recorded all three observations in this audit. It was concluded that there has been progress since the last review; however, there is still potential for better compliance. Recording oxygen saturations especially needs improving and the availability of equipment requires addressing.

Abstract 32: Optimal Threshold for Defining Early Clinical Deterioration as a Predictor of Poor Outcome in Acute Intracerebral Hemorrhage

Background: Many patients with acute intracerebral hemorrhage (ICH) clinically deteriorate between the time of paramedic assessment in the field and Emergency Department (ED) arrival. Cohort studies have used decline in the Glasgow Coma Scale (GCS) score from prehospital assessment to ED assessment to identify patients with early clinical deterioration (ECD), but the degree of GCS decline that best correlates with poor final functional outcome has not been delineated. Methods: Consecutive cases with primary ICH on initial imaging were identified from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial of intravenous magnesium vs. placebo. All subjects underwent GCS evaluation in the field by paramedics within 2 hours from symptom onset, and again in the ED by study research coordinators. Poor outcome was defined as a modified Rankin Scale of 4 to 6 at 3-months. Deteriorations in GCS from one point through 10 points were evaluated in relation to poor final functional outcome through receiver operating characteristic (ROC) and area under curve (AUC). Results: Among the 369 (22%) patients with primary ICH, mean [SD] age was 65 [13] years, 34% were women, 79% White race, 34% Hispanic ethnicity, 80% had pre-existing hypertension, 20% diabetes, 18% smokers. Paramedic on scene time was a median [IQR] of 23 [15-40] minutes from last known well and time of GCS assessment in the ED was a median of 140 [119-175] minutes after last known well. Glasgow Coma Scale scores were mean 14.4 (SD 1.5) and median 15 [15-15] in the field and mean 12.1 (SD 4.5) and median 15 [10-15] in the ED, and 59% had a poor outcome at 3 months. Frequency of deteriorations on the GCS included: ≥1 point - 38%, ≥2points - 31%, ≥3 points - 27%, ≥5 points - 21%, and ≥10 points - 13%. The best performing cutpoints on the the ROC for predicting poor final outcome were ECD definitions of GCS decline of &gt;=1: sensitivity 54% and specificity 85%; and GCS decline of &gt;=2: sensitivity 46% and specificity 91%. The c statistic for ECD defined as a 1 point GCS decline as a predictor of poor final outcome was 0.71 (95%CI 0.66, 0.76). Conclusions: Early clinical deterioration of GCS is common and its presence may be helpful in predicting poor outcome.

Prehospital Trauma Care Registry Problems in South Brazil

ABSTRACTBackgroundTrauma registry remains a great problem to most countries that are implementing trauma systems. Nondigital data assessment and storage may lead to information deterioration along the process. In order to verify the missing registry in prehospital trauma rescuers’ form, we ran this study.Study designA prospective observational noncontrolled study with 288 random trauma cases brought to a Level 1 Trauma Center in Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the student's t-test for continuous variables.ResultsTwo hundred and eighty-eight trauma cases were observed. Twelve patients were excluded. Of the 276 patients who met the including criteria, 75% were men with a mean age of 27-year-old. In only 8.34% of times patients were brought by doctors, while in 91.66% by paramedics. 63.4% of patients were traffic injuries victims, followed by 12.31% falls, 6.52% falls from the high, 5.79% gunshot wounds, 5.34% assaults, 3.62% stab wounds, 2.89% others. Impressively, 16 patients (5.89%) had no records of respiratory rate from the prehospital care assessment, 20 (7.24%) had no data of systolic blood pressure and 13(4.71%)had no pulse registry. Furthermore, 31.25% of the RR not registered were abnormal in the hospital admission evaluation, as well as 15% of the SBPs, and 23% of HR. None of the cases had information regarding time from the scene to the hospital.ConclusionElectronic data collection shall make checklists consistently filled out. It is not well understood the importance of registering data for most of healthcare providers working in the field, especially when they do not follow the in-hospital care of trauma patients.How to cite this articleAbreu-Reis P, Tomasich FS, Nasr A, Collaco I. Prehospital Trauma Care Registry Problems in South Brazil. Panam J Trauma Crit Care Emerg Surg 2014;3(3):97-100.