Biomedical subjects

Erica Caldwell

Publications and source records attributed to Erica Caldwell.

6 recordsLinked to original sources

PubMed2005

An evaluation of compliance with practice guidelines on interhospital trauma transfer.

STUDY OBJECTIVES: To prospectively evaluate compliance with current interhospital trauma transfer guidelines in South West Sydney, before and after an implementation programme was instituted. METHODS: A scoring system was developed to assess compliance with the 11 main components of the guideline. Baseline compliance was measured during an initial 3-month period (pre), followed by an implementation programme to alert staff at referring hospitals to the presence of the guidelines. Following this, compliance was again measured over 3 months (post). RESULTS: Twenty-two patients were transferred during the pre-implementation phase and 35 patients during the post-phase. Overall compliance with the guidelines increased from 62 to 67%. Mean pre-hospital compliance rose from 75 to 95%, and referring hospital compliance rose from 59 to 63%. While there was an improvement in compliance with the use of the dedicated trauma hotline (86-97%), the use of a transfer checklist (41-53%), and appropriateness of transfer (95-100%), none of these reached statistical significance. CONCLUSION: Practice guidelines have been developed to optimise the process of interhospital trauma transfers. An implementation programme met with limited success in improving compliance with the guidelines. Further work is needed to ensure awareness of these guidelines, with ongoing monitoring to ensure best practice and optimal patient outcome.

Adult↗

PubMed2005

Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?

BACKGROUND: The management of patients with hemodynamic instability related to pelvic fracture is a major challenge, with high morbidity and mortality. Evidence-based institutional practice guidelines (PG) were developed as a strategy to optimize the care of these patients. The aims of this study were to evaluate the adherence to the new PG and compare the outcomes before and after their implementation. METHODS: Major blunt trauma patients (Injury Severity Score [ISS] > 15) with hemodynamic instability (initial base deficit > 6 mEq/L or received > 6 units of packed red blood cells [PRBCs] during the first 12 hours) related to pelvic fracture were investigated. Patients presenting with ongoing bleeding from other regions or with severe head injury (Glasgow Coma Scale score < 9) were excluded. The pre-PG group (n = 17) were patients managed during the 18 months ending on December 31, 2001. The post-PG group (n = 14) consisted of patients managed during the subsequent 18 months. Demographics, ISS, shock severity, resuscitation, and outcome data were prospectively collected. The adherence to the key steps of PG was evaluated retrospectively in the pre-PG and prospectively in the post-PG group, including abdominal clearance (AC) with diagnostic peritoneal aspiration/lavage or ultrasound (<15 minutes), noninvasive pelvic binding (PB) (<15 minutes), pelvic angiography (PA) (<90 minutes after admission), and minimally invasive orthopedic fixation (MIOF) (<24 hours). Data are presented as mean +/- SEM or percentages. RESULTS: The pre-PG and post-PG groups were similar regarding age (40 +/- 4 years vs. 42 +/- 6 years), gender (both 71% male), ISS (39 +/- 3 vs. 37 +/- 4), admission base deficit (9 +/- 1 vs. 10 +/- 1) admission systolic blood pressure (116 +/- 7 vs. 112 +/- 6 mm Hg), Glasgow Coma Scale score (12 +/- 1 vs. 12 +/- 1), and PRBC transfusion in the first 12 hours (9 +/- 2 U vs. 9 +/- 2 U). The adherence to the guidelines in the post-PG period was as follows: AC, 100%; PB, 86% (p < 0.05 based on t test or chi test); PA, 93% (p < 0.05 based on t test or chi test); and MIOF, 86%. In the pre-PG period, adherence to the guidelines was as follows: AC, 65%; PB, 0%; PA, 30%; and MIOF 52%. In the post-PG period, the 24-hour PRBC transfusion decreased from 16 +/- 2 U to 11 +/- 1 U and the mortality decreased from 35% to 7% (p < 0.05 based on t test or chi test for both). CONCLUSION: The adherence to the PG as a reflection of optimal management was significantly improved. PG focusing particular on timely hemorrhage control reduced the 24-hour transfusion requirements and the mortality rate in the post-PG group.

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PubMed2005

Abdominal trauma: a disease in evolution.

BACKGROUND: The last decade has seen many changes in the way we investigate and manage abdominal injuries. This study assessed the pattern of abdominal injury and its investigation in patients admitted to a major trauma centre. METHODS: A retrospective registry review of all adult trauma patients admitted to Liverpool Hospital between January 1996 and December 2003 was undertaken. All adult trauma patients were included, identifying mechanism of injury, injury severity score, abbreviated injury score for the abdomen, investigations and intervention. The study period was divided (period 1 from 1996 to 1999, period 2 from 2000 to 2003) and the two periods compared to assess change. RESULTS: The study involved 1224 patients with abdominal injuries. Of these, 969 (79%) were a result of blunt trauma. The main causes were road accidents (61%), interpersonal violence (24%) and falls (7%). Penetrating injury increased from 16% to 25% between the two periods. There were 1274 intra-abdominal injuries, made up of 607 solid organ (liver (n = 220, 36%), spleen (n = 195, 32%), renal (n = 144, 24%) ), 291 hollow viscus (small bowel (n = 160, 55%), large bowel (n = 104, 36%) ) and 168 vascular. Four hundred and thirty-six (36%) patients underwent laparotomy, 65% for blunt trauma. Between the two periods there was a 46% decrease in the use of diagnostic peritoneal lavage, with a 40% increase in computed tomography and 325% increase in focused assessment with sonography for trauma. CONCLUSIONS: This study defined abdominal injury pattern and identified a significant shift in mechanism of injury and abdominal investigation at a major trauma centre during an 8-year study period. Abdominal trauma is indeed a disease in evolution.

Abdominal Injuries↗

PubMed2004

Differences in mortality predictions between Injury Severity Score triplets: a significant flaw.

BACKGROUND: This study investigated the validity of similar Injury Severity Scores (ISS) generated by different Abbreviated Injury Scale triplets. METHODS: A cohort of trauma patients admitted to a single major trauma service between 1995 and 2002 was studied retrospectively. Mortality rates were compared for groups with identical ISS scores but different triplets. RESULTS: For 2,223 of the 5,946 trauma patients studied, 12 ISS scores were generated by two different Abbreviated Injury Scale triplets. Six of these ISS totals showed significant differences in mortality depending on the triplet source. One of the most striking was ISS 25 (triplet 5,0,0), with a mortality of 20.6%, as compared with 0% for triplet 4,3,0 (p = 0.005). The other statistically significant mortality differences for ISS totals were ISS 27-28.6% (5,1,1) versus 7.4% (3,3,3) (p = 0.05); ISS 29-30.3% (5,2,0) versus 4.6% (4,3,2) (p = 0.002); ISS 33-50% (4,4,1) versus 6.7% (5,2,2) (p = 0.034); ISS 34-45.2% (5,3,0) versus 4.3% (4,3,3) (p = 0.0009); and ISS 41-60% (5,4,0) versus 11.1% (4,4,3) (p = 0.05). CONCLUSIONS: The mortality rates are significantly different between pairs of triplets that generate the same ISS total. Caution must be used in the interpretation of outcomes from ISS values generated by different triplets.

Abbreviated Injury Scale↗

PubMed2003

Reduction of time to definitive care in trauma patients: effectiveness of a new checklist system.

This study evaluated the feasibility of establishing a new trauma transfer checklist and assessed its impact on trauma-related interhospital transfers. A standard envelope with a printed checklist (N.E.W.S.) incorporating four key concepts in the care and transfer of trauma patients was used. A prospective comparison of consecutive interhospital trauma transfers to the major trauma service between July 1999-May 2000 (pre-N.E.W.S.) and August 2000-November 2000 (post-N.E.W.S.) was made. Changes in management satisfaction were assessed by a Likert scale (1=poor to 5=excellent). Pre-N.E.W.S., 88 trauma patients were transferred and 20 trauma transfers were recorded post-N.E.W.S. The time to definitive care pre-N.E.W.S. was 443+/-322 min, and 339+/-108 min (P=0.014) post-N.E.W.S. The time in the referring hospital was also reduced from 343+/-310 min pre-N.E.W.S. to 197+/-90 min post-N.E.W.S (P=0.0002). The checklist system prompted changes in the management of the trauma patient in 20% of the cases and there was a high level of satisfaction expressed by users of the checklist (4.6+/-0.7). The N.E.W.S. checklist is effective in facilitating the interhospital transfer of trauma patients by shortening the time to definitive care.

Adult↗

PubMedDate not supplied

Difference in trauma team activation criteria between hospitals within the same region.

OBJECTIVES: The present study was conducted to establish the current criteria for trauma team activation (TTA) in hospitals in the Metropolitan Sydney area, and examine the rationale behind their use. METHODS: A cross-sectional survey was undertaken of the seven hospitals in the Metropolitan Sydney area designated to receive adult major trauma in March 2004. Trauma coordinators in each hospital provided the criteria used for adult TTA within their hospital. RESULTS: All seven hospitals replied with their TTA criteria and completed the survey. The results show a wide variation in those criteria used by hospitals to activate their trauma team. Universally used criteria included penetrating injury to the head, neck or torso, limb amputation, spinal cord injury and systolic blood pressure <90 mmHg. Physiological limits for TTA varied between hospitals, with different limits for pulse rate and GCS used in different hospitals. All hospitals used mechanism of injury criteria alone as an activation prompt. CONCLUSIONS: The criteria for TTA differ between hospitals within the same region. The criteria currently used will result in over-triage of trauma patients, but this might be of benefit in training the trauma team in centres that do not see a large volume of trauma patients. There are several advantages in standardization of criteria including optimization of patient care, training, research and audit. Further work is needed to validate existing criteria for use throughout the region.

Adult↗