Trauma surgery & acute care open
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Trauma Surg Acute Care Open · Jan 2020
ReviewMaximizing the potential of trauma registries in low-income and middle-income countries.
Injury is a major global health issue, resulting in millions of deaths every year. For decades, trauma registries have been used in wealthier countries for injury surveillance and clinical governance, but their adoption has lagged in low-income and middle-income countries (LMICs). Paradoxically, LMICs face a disproportionately high burden of injury with few resources available to address this pandemic. ⋯ While the implementation of these trauma registries is a positive step forward in addressing the injury burden in LMICs, numerous challenges still stand in the way of maximizing the potential of trauma registries to inform injury prevention, mitigation, and improve quality of trauma care. This paper outlines several of these challenges and identifies potential solutions that can be adopted to improve the functionality of trauma registries in resource-poor contexts. Increased recognition and support for trauma registry development and improvement in LMICs is critical to reducing the burden of injury in these settings.
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Trauma Surg Acute Care Open · Jan 2020
Optimizing the trauma resuscitation bay during the covid-19 pandemic.
The covid-19 global pandemic due to the SARS-CoV2 (CoV2) virus has created the need to adapt hospital workspaces and staffing models, and trauma is no exception. While the optimal configuration of a trauma resuscitation area is debatable, the space needs to be large enough to accommodate the trauma team and ancillary staff. ⋯ Lastly, stores of personal protective equipment in the form of fluid resistant gowns, head covering, face shield, and gloves (both sterile and non-sterile) should be readily available but under strict access. As CoV2 carriers increased in our population in New Jersey, we treated each incoming trauma patient as a potentially CoV2-positive case and sought to reconfigure out trauma resuscitation area to minimize exposure of our supplies to aerosolized virus.
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Trauma Surg Acute Care Open · Jan 2020
Long-term patient-reported outcome measures after injury: National Trauma Research Action Plan (NTRAP) scoping review protocol.
A significant proportion of patients who survive traumatic injury continue to suffer impaired functional status and increased mortality long after discharge. However, despite the need to improve long-term outcomes, trauma registries in the USA do not collect data on outcomes or care processes after discharge. One of the main barriers is the lack of consensus regarding the optimal outcome metrics. ⋯ This scoping review will provide information regarding the currently available metrics for tracking functional and patient-reported outcomes after injury. The review will be presented to a multi-disciplinary stakeholder group that will evaluate these outcome metrics using an online Delphi approach to achieve consensus as part of the development of the National Trauma Research Action Plan (NTRAP). The results of this review will be presented at relevant national surgical conferences and published in peer-reviewed scientific journals.
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Trauma Surg Acute Care Open · Jan 2020
Attenuation of MODS-related and ARDS-related mortality makes infectious complications a remaining challenge in the severely injured.
The recent decrease in multiple organ dysfunction syndrome (MODS)-associated and adult respiratory distress syndrome (ARDS)-associated mortality could be considered a success of improvements in trauma care. However, the incidence of infections remains high in patients with polytrauma, with high morbidity and hospital resources usage. Infectious complications might be a residual effect of the decrease in MODS-related/ARDS-related mortality. This study investigated the current incidence of infectious complications in polytrauma. ⋯ Population-based cohort study.
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Trauma Surg Acute Care Open · Jan 2020
ReviewHealth system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review.
Africa accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa. ⋯ Although research on health system factors and its influence on post-trauma mortality at the pre-hospital care level in Africa are limited, anecdotal evidence suggests that access to pre-hospital care interventions, the level of provider skills and referral pathways are important determinants of mortality outcomes. The strength of their influence will require well designed studies that could incorporate mixed method approaches. Moreover, similar reviews incorporating other LMICs are also warranted. Key Words: Health System Factors, Emergency Medical Services [EMS], Pre-hospital Care, Post-Trauma mortality, Africa.