Trauma Patients In Prehospital Setting Research Articles

Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review

ObjectiveIn the UK there are around 5400 deaths annually from injury. Tranexamic acid (TXA) prevents bleeding and has been shown to reduce trauma mortality. However, only 5% of UK major...

Accidental hypothermia and related risk factors among trauma patients in prehospital setting

INTRODUCTION: Hypothermia is highly prevalent among trauma patients. If hypothermia is diagnosed and managed early, complications from hypothermia can be reduced. This study aimed to determine the prevalence of accidental hypothermia and related factors in prehospital trauma patients. MATERIAL AND METHODS: This is a single-center prospective observational study. From 2 to 16 November 2018, 132 trauma patients were selected by convenience sampling. To collect data, the patient’s core body temperature (CBT) and the temperature of the ambulance cabin were measured as the patient left the ambulance. A combination of observation and emergency medical technician records was used to identify factors influencing hypothermia onset or exacerbation. SPSS 16 was used to analyze the data using descriptive statistics and multiple logistic regression. A significance level of 5% was considered. RESULTS: It was calculated that 44.1% of prehospital trauma patients had accidental hypothermia. The predicting variables for accidental hypothermia in trauma patients were found to be level of consciousness (OR = 2.19, p < 0.049), pulse rate (OR = 1.04, p < 0.02), and ambient cabin temperature (OR = 1.32, p < 0.015). CONCLUSIONS: At the time of hospital admission, a significant number of trauma patients were hypothermic. This study emphasizes the need for identifying unintentional hypothermia in trauma patients early on during the pre-hospital stage.

The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan

BackgroundEmergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important factors in assessing critically ill or injured patients in the prehospital setting. However, it has been reported that documentation of pediatric vital signs is sometimes omitted, and little is known regarding the performance rate of vital sign documentation by EMS providers in Japan. Using a nationwide data base in Japan, this study aimed to evaluate the relationship between patients’ age and the documentation of vital signs in prehospital settings.MethodsThis study was a secondary data analysis of the Japan Trauma Data Bank. The inclusion criterion was patients with severe trauma, as defined by an Injury Severity Score ≥ 16. Our primary outcome was the rate of recording all four basic vital signs, namely blood pressure, heart rate, respiratory rate, and level of consciousness in the prehospital setting among different age groups. We also compared the prehospital vital sign completion rate, that is, the rate at which all four vital signs were recorded in a prehospital setting based on age groups. Multivariate analysis was performed to evaluate factors associated with the prehospital vital sign completion rate.ResultsWe analyzed 75,777 severely injured patients. Adults accounted for 94% (71400) of these severely injured patients, whereas only 6% of patients were children. The rate of prehospital recording of vital signs was lower in children ≤5 years than in adult patients for all four vital signs. When the adult group was used as a reference, the adjusted odds ratios of vital sign completion rate in infants (0 years), younger children (1–5 years), older children (6–11 years), and teenagers (12–17 years) were 0.09, 0.30, 0.78, and 0.87, respectively.ConclusionsAnalysis of the nationwide trauma registry showed that younger children tended to have a lower rate of vital sign documentation in prehospital settings.

A report on the experience of using ultrasound by emergency medical technicians in dealing with trauma patients in pre-hospital setting: a pilot study

Objective: The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints. Methods: This semi-experimental study was conducted in Tehran, Iran. Twenty EMTs were selected purposefully and underwent a training program. Thereafter, they were asked to perform extended focused assessment with sonography in trauma (eFAST) using a handheld ultrasound device on trauma patients, and also filled a questionnaire prepared (in four components including C1: coherence, C2: cognitive participation, C3: collective action, and C4: reflexive monitoring) based on the normalization process theory (NPT). Results: All 20 participants were men and their average age was 37.8 years (SD = 4.7). For C1, the median total score was 10.5 out of a score of 4-20; For C2, the median score was 6 out of 3-15; For C3, the median total score was 18 out of a score of 6-30; and for C4, the median total score was 11 out of a score of 5-25. Conclusion: Overall, it seems that EMTs welcomed using ultrasonography in dealing with trauma patients in pre-hospital setting. Although they thought that it might somewhat lead to an increase in their workload; but they believed that sufficient training was not provided for them yet. The EMTs were uncertain about the viewpoints of the patients and did not know how it could affect patients’ outcome.

Shock Index as a Marker for Mortality Rates in Those Admitted to the Medical Intensive Care Unit from the Emergency Department.

ObjectiveShock index (SI) is defined as the heart rate divided by systolic blood pressure. Studies have shown a correlation between the shock index and mortality in trauma patients in prehospital settings and in the emergency department (ED). The objective of this study was to identify the utility of SI in predicting mortality in the medical intensive care unit (MICU) patients admitted from the ED and transfers from the floor to MICU. DesignWe performed a retrospective analysis of adult patients admitted to the MICU at our urban trauma hospital between January 2015 through August 2015 using ED vital signs to calculate the shock index and identify inpatient deaths. Similar data were examined for inpatient transfers to the MICU.ResultsNine hundred and fifty patients were included in the study; 743 had an SI ≤ 0.99 with a mortality rate of 15.9%. Two hundred and seven patients had a SI ≥ 1.00 with a mortality rate of 22.7%. A higher SI was significant for mortality. There was no statistical significance in SI and mortality rate for patients transferred from the medical floor to the ICU.ConclusionsPatients with an SI ≥ 1.00 from initial ED vital signs correlated with a higher mortality rate. In patients transferred from the floor to MICU, SI ≥ 1.00 did not correlate with a higher mortality rate.

Association of prehospital oxygen administration and mortality in severe trauma patients (PROMIS): A nationwide cohort study.

Until now, we routinely administered oxygen to trauma patients in prehospital settings irrespective of whether oxygen delivery affected the prognosis. To determine the necessity of prehospital oxygen administration (POA) to trauma patients, we aimed to assess whether POA contributed to in-hospital mortality.This was a multicenter propensity-matched cohort study involving 172 major emergency hospitals in Japan. During 2004 to 2010, 70,683 patients with trauma aged ≥15 years were eligible for enrolment. The main outcome measures were survival until hospital discharge after POA, and propensity score analyses were used to adjust for patient factors and hospital site.Of 32,225 trauma patients, 19,985 (62.0%) were administered oxygen by the emergency medical services in prehospital settings and 12,240 (38.0%) did not receive oxygen. Overall, 29,555 patients (90.7%) survived till hospital discharge. In the multivariable unconditional logistic regression, POA had an odds ratio (OR) of 0.33 (95% confidence interval [CI], 0.30–0.37; P <.001) for favorable in-hospital mortality. Furthermore, there were significant differences in all the important variables between the POA and no POA groups (P <.001); therefore, we used propensity score matching analysis. After adjustment for the covariates of selected variables, we found that POA was not associated with a higher rate of survival after hospitalization (adjusted OR, 1.02; 95% CI, 0.99–1.04; P = .27). Even after adjustment for all covariates, POA did not improve in-hospital mortality (adjusted OR, 1.01; 95% CI, 0.99–1.03; P = .08).In this study, POA did not improve in-hospital mortality in trauma patients. However, further studies are needed to validate our results.

Efficacy of Cervical Immobilization in Multiple Trauma Patients

Immobilization is one of the most used procedures to prevent spinal cord injury in multiple trauma patients in prehospital setting. However, its protocolary use has historical principles rather than a scientific origin. Although this technique restricts the movement of the injured spine, there is no evidence supporting its use in all patients suffering from trauma.

Early diagnosis of traumatic intracranial hematomas.

.Timing of the intervention for intracranial hematomas is critical for its success, specifically since expansion of the hemorrhage can result in debilitating and sometimes fatal outcomes. Led by Britton Chance, we and an extended team from University of Pennsylvania, Baylor and Drexel universities developed a handheld brain hematoma detector for early triage and diagnosis of head trauma victims. After obtaining de novo Food and Drug Administration clearance, over 200 systems are deployed in all Marine battalion aid stations around the world. Infrascanner, a handheld brain hematoma detection system, is based on the differential near-infrared light absorption of the injured versus the noninjured part of brain. About 12 independent studies have been conducted in the USA, Canada, Spain, Italy, the Netherlands, Germany, Russia, Poland, Afghanistan, India, China, and Turkey. Here, we outline the background and design of the device as well as clinical studies with a total of 1293 patients and 203 hematomas. Infrascanner demonstrates high sensitivity (adults: 92.5% and children: 93%) and specificity (adults: 82.9% and children: 86.5%) in detecting intracranial hematomas in volume and from the surface of the brain. Infrascanner is a clinically effective screening solution for head trauma patients in prehospital settings where timely triage is critical.

Development and domestication of a clinical guideline for pharmacological pain management of trauma patients in prehospital setting

Introduction: Inadequate management of acute traumatic pain in the prehospital stage is a fact, which has many physical and mental adverse effects. No clinical guideline for the pain management of prehospital trauma patients in Iran has been published yet. Aims: This study aimed at development and domestication of a clinical guideline for pharmacological management of pain in prehospital trauma patients. Materials and Methods: A multistage evolutionary study method was used. First, a systematic review of articles, books, and guidelines for prehospital acute pain management with a comprehensive approach was carried out, then clinical guidelines with the most relevance to the topic were selected, and their quality was evaluated with AGREE tools. Finally, the initial guideline was developed based on the recommendations of the most comprehensive ones. The Delphi method and experts panel were used to summarize the information and finalize the clinical guidelines recommendations. Results: A total of 38 clinical guidelines and 150 related articles were found, of which five more comprehensive clinical guidelines and the most relevant topics were identified and reviewed. The recommendations that were agreed on by the Delphi stage were considered as the final recommendations, and others were reviewed again in the panel of experts by making the necessary changes. Finally, the domestic clinical guideline with 52 recommendations in three areas (general, assessment, and drug recommendations) was developed. Conclusions: Iran prehospital emergency organizations can use the recommendations of this clinical guideline to improve the quality of care, satisfaction, and protect patients' right.