Trauma Audit And Research Network Database Research Articles

Patterns of major trauma admissions to a level 1 trauma centre: A five year database analysis

IntroductionIt is only in recent years that major trauma systems and networks have been operating in the UK. High-quality data is available from the Trauma Audit and Research Network (TARN) database, enabling regional analysis. Our aim was to analyse Trauma Team Activations within the Cheshire and Merseyside major trauma network and discuss the implications of these data on resource allocation, training and trauma prevention. MethodsA retrospective analysis was performed for all patients requiring Trauma Team Activation (TTA) at a category one adult Major Trauma Centre (MTC) who were submitted to the TARN database from the 1st January 2015 to the 1st January 2020.Data collected included the date and time of arrival, location of injury and Injury Severity Score (ISS) in addition to routine demographic data. Dates of major sporting events and school holidays were obtained. Results4811 patients were identified. The median age was 57 years; 65.8 % were male. The mean frequency of TTAs was 18.5 per week. Patterns identified include annual peaks during the summer months, October and December, weekly peaks on Thursdays and Sundays and daily peaks between 16:00 and 23:59 with 45.0 % of TTAs occurring between these hours.There were 5.9 additional TTAs per week during the Isle of Man TT races. The median ISS increased from 14 to 23 for TT race TTAs and from 14 to 36 for Manx Grand Prix TTAs. Those injured during the TT races were twice as likely to require surgery and those injured during the MGP required five additional days in intensive care. School holidays did not independently affect major trauma volumes. ConclusionsMajor trauma in Cheshire and Merseyside did follow distinct patterns according to calendar month, day and time. Major motorsport increased trauma volumes and severity; school holidays did not. Such analysis could enable Major Trauma Centres to tailor the supply of trauma services to meet a predictable local demand for the benefit of our staff and patients.

Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools

BackgroundMajor incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients—those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have...

WTP4.14 Major Trauma Amongst E-scooter and Bicycle Users: A Nationwide Cohort Study

Abstract Aims To determine the number of E-Scooter related admissions due to significant trauma in comparison to bicycle related trauma within England and Wales. To compare morbidity and mortality associated with each form of transport. Methods A retrospective cohort study based on data which has been prospectively collected and submitted to the UK Trauma Audit and Research Network (TARN) registry. Patients of any age who were admitted to major trauma centres or trauma units in England and Wales with injuries following E-Scooter or bicycle incidents between the dates 01/01/2021- 31/12/2021. All patients must have met TARN database inclusion criteria. Results There were 293 E-Scooter trauma incidents compared to 2538 bicycle incidents. E-Scooter users were more likely to be admitted to a major trauma centre (p=0.019) or an intensive care unit (p=<0.001). Amongst e-scooter users, serious head injury (Abbreviated Injury Scale >2) was almost twice as common (p=<0.001) and the rate of serious limb trauma was also higher in this group (p=<0.001). Rates of serious chest and pelvic trauma were greater in the bicycle cohort (p=<0.001 and p=0.003 respectively). Over a third of E-Scooter injuries were incurred outside the remit of current legislation by patients who were under the influence of alcohol and drugs (75/293) or under the age of 17 (41/293). Conclusions The relative incidence of moderate to severe injury amongst E-Scooter users is likely to outweigh bicycle users. These early results suggest an alternative pattern of injury amongst E-scooter users compared to bicycles.

MP02-10 UROLOGY DIRECTED MANAGEMENT OF HIGH GRADE RENAL TRAUMA IS ASSOCIATED WITH A LOW RATE OF EMERGENCY NEPHRECTOMY/RENORRHAPHY

You have accessJournal of UrologyCME1 Apr 2023MP02-10 UROLOGY DIRECTED MANAGEMENT OF HIGH GRADE RENAL TRAUMA IS ASSOCIATED WITH A LOW RATE OF EMERGENCY NEPHRECTOMY/RENORRHAPHY Aisling Fawaz, Robert Keenan, and Elaine Redmond Aisling FawazAisling Fawaz More articles by this author , Robert KeenanRobert Keenan More articles by this author , and Elaine RedmondElaine Redmond More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Major trauma care in Ireland is managed through a multidisciplinary collaborative approach between trauma surgeons and organ subspecialists e.g. urologists, cardiothoracic surgeons, neurosurgeons etc. Thus the urology service directs the management of all urological trauma irrespective of the grade of injury or other organ involvement. This is in contrast to the management of trauma care in other jurisdictions such as the United States where the majority of trauma cases are primarily managed by trauma surgeons with other specialities consulted as required. One recent study found that urology was consulted in only 15% of high grade renal trauma cases presenting to their institution even though urology consultation was associated with a lower nephrectomy rate (36.4% vs 78.8%).1 We hypothesised that the standardised urology directed care of renal injuries in Ireland would be associated with comparatively higher rates of renal preservation and reduced intervention/nephrectomy. The aim of our study was to evaluate the management of high grade renal trauma in Ireland using data derived from the Irish Major Trauma Audit which is stored on the Trauma Audit and Research Network (TARN) database. METHODS: The TARN database was used to identify all cases of significant renal trauma presenting to the 26 trauma receiving hospitals in Ireland between 2014 and 2020. Demographic data, mechanism of injury, injury characteristics, management and patient outcomes were analysed. RESULTS: There were a total of 426 renal trauma cases recorded during the study period, of which 305 patients had a high grade renal injury. The majority of patients in this group were male (241 (79%)). The median age was 28 years (range: 0.3-93.9 years). There were 276 cases of blunt renal trauma (90%) and 29 cases of penetrating trauma (10%). The most common cause for blunt renal trauma was road traffic accident. 65 patients (21%) required blood or blood products. Seven patients underwent emergency nephrectomy or renorraphy (2%). CONCLUSIONS: The need for emergency nephrectomy due to high grade renal trauma in Ireland is exceedingly rare. We conclude that an integrated multidisciplinary approach to trauma care results in a higher likelihood of avoiding intervention in this cohort of patients. 1Wang SL, Agrawal P, Rostom M, Gupta N, et al. Urology Consult: Association with Renal Trauma Imaging and Intervention. Urology 2022 (In press) Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e14 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aisling Fawaz More articles by this author Robert Keenan More articles by this author Elaine Redmond More articles by this author Expand All Advertisement PDF downloadLoading ...

Major trauma among E-Scooter and bicycle users: a nationwide cohort study

ObjectivesTo determine the incidence, demographics and injury patterns involved in E-Scooter-related hospital admissions due to significant trauma compared with bicycle-related trauma within England and Wales. To compare morbidity and mortality...

WE7.6 Failure of intensive monitoring in high grade blunt splenic injury: an important consideration beyond NOM failure

Abstract Aims Non-operative management (NOM), including intensive monitoring (IM) and angioembolisation (AE), is the standard of care for haemodynamically stable patients with blunt splenic injury to preserve spleen and it's function. Internal review of local Level 1 Trauma Center revealed a NOM failure rate of 4.4%, but an IM failure rate of 16.2% in high grade blunt splenic injury (HGBSI). Age, Injury Severity Score (ISS) and moderate to severe injuries are predictors for NOM failure. However, predictors of IM failure, which can be successfully treated with AE, is not well understood, motivating the current study. Methods Patients with BSI are identified from Trauma Audit and Research Network (TARN) databse from 2015–2020. Clinical, biochemical and radiological data were collated from TARN database and electronic medical records. HGBSI is defined as AAST grade III to V. Results Sixty-eight patients with HGBSI were identified. Seventy-eight percent (n=53) were initially managed with IM, with 21% (n=11) requiring subsequent interventions. Majority who failed IM were involved in road traffic accident compared to other causes (p-value=0.035). In addition, a higher proportion had systole blood pressure<90mmHg (p-value=0.033) and pH<7.2 (p-value=0.038) at presentation. AAST grade, ISS or age did not influence requirement for further intervention. Nine of the eleven patients were treated successfully with AE. Conclusion Understanding predictors of IM failure will enable better selection of patients for AE at initial presentation, leading to potential reduction in duration of IM, length of stay and blood transfusion. Preliminary work using machine learning algorithm to predict IM failure with larger dataset is on-going.

Mortality and morbidity of stairlift injuries: Analysis of the UK TARN database

AimsTo investigate the incidence and pattern of injury in patients with a diagnosis of a fall from a stairlift. MethodsData was analysed from the Trauma Audit and Research Network (TARN) database from 2000 to 2018 for those recorded suffering stairlift related injuries between the ages of 40–100 years. Patient demographics, injury mechanism and pattern, mortality rate and height of fall were analysed. Results1069 patients were identified in the initial search with 651 having an eligible mechanism of injury. The mean age was 82 (range 41.4–100.1) years. The most common site of injury was the limbs (49.2%) with the most severe injuries to the head (mean AIS 3.1). The mean ISS was 12.5 (Range 1–75). There was no relationship between height of fall and ISS (rs 0.054 p = 0.4). Individuals were 78% more likely to have an ISS score of 15 or more if they had a head injury, (OR: 0.12; 95% CI: 0.06–0.24) and 79% more likely to have sustained an injury to the thorax (OR: 0.21; 95% CI: 0.11–0.41). Injury to the head was 95% more likely in individuals with an ISS score greater than 25 points or more (OR: 0.05; 95% CI: 0.01–0.16) and 69% more likely for those who sustain injury to the thorax. Individuals with an ISS score of 25 points or more were 18 times more likely to have sustained injury getting off their stair lift compared to any other method of falling from their stair lift. Mortality was associated with injuries to the thorax in those aged 70 years or below, injuries to the face, spine and limb for those aged 71–85 years and with head injury in those over 85 years. The overall mortality rate was 15.7%. ConclusionFalls from stairlifts commonly result in limb injuries and most severe injuries are sustained to the head. When patients fall getting off from astairlift, have injuries to their head or thorax they have a higher ISS. The overall mortality is 15.7%. Given the increasing use of stairlifts in our ageing population, strategies should be considered to make these safer.

Implementation of tranexamic acid for bleeding trauma patients: a longitudinal and cross-sectional study

ObjectiveTo describe the use of tranexamic acid (TXA) in trauma care in England and Wales since the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial results were published...

Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales

ObjectiveTo describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales.DesignPopulation-based analysis of the UK Trauma Audit and Research Network (TARN) database.Patients and settingAll paediatric...

35 To pan-scan or not to pan-scan? Further analysis of the tarn database 2012–2017

BackgroundA ‘whole body’ or ‘pan-scan’ computed tomography (CT) imaging approach is now becoming the standard of care during the early management of adult patients with suspected severe blunt multitrauma. A...

The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage

IntroductionTriage is a key principle in the effective management of a major incident. Existing triage tools have demonstrated limited performance at predicting need for life-saving intervention (LSI). Derived on a...

PAEDIATRIC OUT-OF-HOSPITAL TRAUMATIC CARDIAC ARREST: A REVIEW OF THE PS14 SURVIVAL PREDICTION MODEL

Objectives & BackgroundTrauma is a leading cause of death in children. Paediatric out-of-hospital traumatic cardiac arrest (POOHTCA) is a subsection of this. The Ps14 survival prediction model is used to...

OLDER PEOPLE ARE NOT ALL THE SAME: LESSONS FROM A MAJOR TRAUMA DATABASE

Objectives & BackgroundWhile there is extensive research on the differences between older and younger patients with serious injuries, little is known about variations within the older age group. However, increased...

Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis

BackgroundHistorically, reported survival from traumatic cardiac arrest (TCA) was extremely low. More recent publications have recorded survival to discharge of up to 8%. This improvement is likely to be multi-factorial; however, there are currently no published data describing the epidemiology or aetiology of TCA in England and Wales to guide future practice improvement. MethodsPopulation-based analysis of 2009–2015 Trauma Audit and Research Network (TARN) data. The primary aim was to describe the 30-day survival following TCA. Patients of all ages with traumatic cardiac arrest pre-hospital or in the emergency department (ED) were included. Data are described as number (%), and median [interquartile range]. Two-group analysis with Chi-squared test was performed. ResultsDuring the study period 227,944 patients were included in the TARN database. Seven hundred and five (0.3%) suffered TCA: 74.3% were male, aged 44.3 [25.2–83.2] years, ISS 29 [21–75], and 601 (85.2%) had blunt injuries. 612 (86.8%) had a severe traumatic brain injury and or severe haemorrhage.Overall 30-day survival was 7.5% (95%CI 5.6–9.5) — ‘pre-hospital only’ TCA 11.5%, ‘ED only’ TCA 3.9%, p<0.02. No patients who were in TCA both pre-hospital and in the ED survived. ConclusionThis study has shown that short-term survival from TCA in this large civilian registry is 7.5%. Early and aggressive management of patients with TCA, using protocols that target the reversible causes of TCA, should be initiated. Further work to establish novel ways to manage patients with reversible causes of TCA is indicated. Resuscitation in this patient group is not futile.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales

IntroductionNon-compressible torso haemorrhage (NCTH) carries a high mortality in trauma as many patients exsanguinate prior to definitive haemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct...

Prediction modelling for trauma using comorbidity and ‘true’ 30-day outcome

BackgroundPrediction models for trauma outcome routinely control for age but there is uncertainty about the need to control for comorbidity and whether the two interact. This paper describes recent revisions...

DEATH AND SERIOUS INJURY CAUSED BY STABBING IN ENGLAND AND WALES 2000–2010

Objectives & BackgroundFollowing a spate of high profile murders there is concern that injuries and deaths caused by knives is increasing in England and Wales, especially within the teenage population....

Civilian firearm injury and death in England and Wales

IntroductionThere is currently concern in the UK that injuries and deaths caused by firearms are increasing. This is supported by small local studies but not by wider research to inform...

003 Whole Body CT scanning for severe blunt multitrauma: analysis of the TARN database 2005–2010

Objectives and BackgroundsThere is growing evidence to recommend the use of “Whole Body” CT (WBCT) scanning in the early management of severe blunt multitrauma patients. A recent study [Lancet 2009;373:1455–61]...

Testing the Validity of the ATLS Classification of Hypovolaemic Shock

The Advanced Trauma Life Supports (ATLS) classification of hypovolemic shock is often used resuscitating patients with major trauma. Although cited by numerous articles and guidelines, its sensitivity and specificity for shock are unclear. This retrospective study sought to assess the validity of the ATLS classification of shock by comparing it with physiological data recorded in the emergency department (ED) from patients in the Trauma Audit and Research Network (TARN) database. Admission physiology, injury, and outcome variables from 107,649 injured adult patients presenting to hospitals in England and Wales between 1989 and 2007 were included. Eligible patients were those sustaining traumatic injury necessitating admission to the hospital for≥3 days, transfer for more advanced care, or death within 93 days. Eligible patients were divided into groups representing the four ATLS shock subgroups, based on their presenting heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR), and Glasgow Coma Scale score (GCS). Although ATLS class IV shock is characterized by HR>140 beats/min, RR>35 breaths/min, and a reduced SBP, the physiologic data from the TARN database reveals that in patients with HR>140 beats/min, the median RR was only 24 breaths/min and the upper quartile was only 30 breaths/min. In addition, few patients would have met the standard definition of hypotension and thus qualified as class IV shock, as the median SBP for injured patients with a median age of 35 years was 130 mm Hg and the lower quartile was 103 mm Hg. Although these results indicate there likely is an association between elevated HRs, lowered SBPs, and raised RRs, these changes do not always occur simultaneously and to the degree indicated by the ATLS classification of shock. Based on this, the authors concluded that for both blunt and penetrating trauma patients, ATLS seems to overestimate the degree of hypotension and tachypnea associated with tachycardia.