• Defining major trauma: a literature review

      Thompson, Lee; Hill, Michael; Shaw, Gary (2019-06-01)
      Introduction: Major trauma in the elderly population has been increasingly reported over the past decade. Compared to younger populations, elderly patients may experience major trauma as a result of low mechanisms of injury (MOIs) and as a result, existing definitions for ‘major trauma’ should be challenged. This literature review provides an overview of previous conceptualisations of defining ‘major trauma’ and considers their utility in relation to the pre-hospital phase of care. Methods: A systematic search strategy was performed using CINAHL, Cochrane Library and Web of Science (MEDLINE). Grey literature and key documents from cited references were also examined. Results: A total of 121 articles were included in the final analysis. Predominantly, retrospective scoring systems, such as the Injury Severity Score (ISS), were used to define major trauma. Pre-hospital variables considered indicative of major trauma included: fatal outcomes, injury type/pattern, deranged physiology and perceived need for treatment sequelae such as intensive care unit (ICU) admission, surgical intervention or the administration of blood products. Within the pre-hospital environment, retrospective scoring systems as a means of identifying major trauma are of limited utility and should not detract from the broader clinical picture. Similarly, although MOI is often a useful consideration, it should be used in conjunction with other factors in identifying major trauma patients. Conclusions: In the pre-hospital environment, retrospective scoring systems are not available and other variables must be considered. Based upon this review, a working definition of major trauma is suggested as: ‘A traumatic event resulting in fatal injury or significant injury with accompanying deranged physiology, regardless of MOI, and/or is predicted to require significant treatment sequelae such as ICU admission, surgical intervention, or the administration of blood products’. Abstract published with permission.
    • Evaluation of pre-hospital point-of-care testing for lactate in sepsis and trauma patients

      Younger, Paul; McClelland, Graham (2014-10)
      Abstract published with permission. Objective: Lactate is a significant marker of critical illness and mortality in sepsis and trauma patients. The purpose of this study is to evaluate point-of-care lactate testing by paramedics in a UK ambulance service. Methods: Selected enhanced care paramedics were trained to use the lactate meter in patients with suspected sepsis and patients who trigger the major trauma bypass protocol. Feedback was collected on the practicalities of using the meter and the potential impact on the diagnosis of sepsis. Results: Data were collected on 114 patients, 96% had suspected sepsis (n=109) and 4% (n=5) were patients who had sustained trauma. The participants found that the ability to take lactate readings was useful and increased their confidence in their clinical decision making. Conclusions: Point-of-care lactate measurement is feasible in pre-hospital care and appears to support paramedics in their decision making.
    • Identifying pre-hospital factors which influence outcome for major trauma patients in a regional Trauma Network: an exploratory study

      Thompson, Lee; Hill, Michael; Davies, Caroline; Shaw, Gary (2016-09)
      Background Major trauma is often life threatening or life changing and is the leading cause of death in the United Kingdom for adults aged≤45 years. The aim of this exploratory study was to identify pre-hospital factors influencing patient outcomes for major trauma within the Northern Trauma Network. Method Secondary data analysis of a combined data set of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (n=1033) was undertaken. Variables included mechanism of injury, age, physiological indices, timings and skill mix. Principle outcome measures included Mortality data and Glasgow Outcome Scales. Results Glasgow Coma Scores proved a significant predictor of mortality in major trauma (p<0.00). Amongst other physiological indices, systolic blood pressure ≤90 mm Hg. was associated with both increased mortality (p≤0.004) and poorer morbidity (p≤0.021). Respiration rate <14/minute was also significantly predictive of morbidity (p≤0.03) and mortality (p<0.00). Prolonged response times to the most critically injured patients (p<0.031), and increasing casualty age were significantly associated with poorer outcomes. The attendance of a Doctor was significantly associated with increased mortality (p≤0.036) perhaps validating existing resource despatching practices. Predictors of positive outcomes included the presence of a Doctor when on-scene time ≤50 minutes (p≤0.015), crew arrival on-scene ≤10 minutes (p<0.046) and on-scene time ≤50 minutes (p<0.015). Conclusion These findings validate GCS, BP and Respiratory Rate values as valid triggers for transport to a Major Trauma Centre. Analysis of the interactions between arrival time, time-on-scene, skill mix and age demand further exploration but tentatively validate the concept of a ‘Golden Hour’ and suggest the potential value of a ‘load and go and play on the way’ approach. https://emj.bmj.com/content/emermed/33/9/e5.1.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ 10.1136/emermed-2016-206139.18
    • Trauma systems: the anticipated impact of trauma divert in the North East

      Moy, R.; Denning, J.; Han, Kyee (2011-11)
      Introduction The advent of the new Trauma Network system will drive significant changes in the transport of trauma patients. We aimed to find out what the impact of the new trauma network would be on the two prospective trauma centres in the Northern region, in terms of increased workload. This could allow the centres to gain additional resources to provide care for these patients. Methods We conducted a retrospective audit of all trauma patients conveyed by North East Ambulance service during the month of October 2009. These patients were then assessed by the London Ambulance Service Trauma Divert Criteria. Any patients who would have bypassed their local hospital, and been taken to the nearest trauma centre were identified. Also identified were any patients at risk of airway compromise, who would have been transported to the nearest ED for stabilisation and secondary transfer. Patients transported by air ambulance were excluded, as they are already taken to the Trauma Centres. Results 3500 patients were identified during the initial search. Of these, 70 met the criteria for bypass, although 16 were transported to trauma centres as the nearest hospitals. 54 were transported to their nearest hospital, although under the criteria used, would have been taken to a trauma centre. 8 met the criteria for transfer to the nearest hospital, for airway protection. Based on geography of receiving hospital, we estimate that an additional 17 patients would have gone to James Cook University Hospital, and 29 to Newcastle General Hospital. Conclusion We conclude that introduction of the bypass guidelines would lead to an additional 46 patients being taken to a trauma centre in that month. This suggests that specific arrangements may need to be made to deal with the extra workload, and further investment may be required. https://emj.bmj.com/content/emermed/28/11/e2.15.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2011-200645.8