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Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study
OBJECTIVES: To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN: Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING: Major trauma centre in India. PARTICIPANTS: Injured patients be...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311027/ https://www.ncbi.nlm.nih.gov/pubmed/32565447 http://dx.doi.org/10.1136/bmjopen-2019-033236 |
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author | Mitra, Biswadev Kumar, Vineet O'Reilly, Gerard Cameron, Peter Gupta, Amit Pandit, Amol P Soni, Kapil D Kaushik, Gaurav Mathew, Joseph Howard, Teresa Fahey, Madonna Stephenson, Michael Dharap, Satish Patel, Pankaj Thakor, Advait Sharma, Naveen Walker, Tony Misra, Mahesh C Gruen, Russell L Fitzgerald, Mark C |
author_facet | Mitra, Biswadev Kumar, Vineet O'Reilly, Gerard Cameron, Peter Gupta, Amit Pandit, Amol P Soni, Kapil D Kaushik, Gaurav Mathew, Joseph Howard, Teresa Fahey, Madonna Stephenson, Michael Dharap, Satish Patel, Pankaj Thakor, Advait Sharma, Naveen Walker, Tony Misra, Mahesh C Gruen, Russell L Fitzgerald, Mark C |
author_sort | Mitra, Biswadev |
collection | PubMed |
description | OBJECTIVES: To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN: Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING: Major trauma centre in India. PARTICIPANTS: Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. INTERVENTION: A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. MAIN OUTCOME MEASURES: The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. RESULTS: Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). CONCLUSIONS: The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. TRIAL REGISTRATION NUMBER: NCT02877342. |
format | Online Article Text |
id | pubmed-7311027 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-73110272020-06-26 Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study Mitra, Biswadev Kumar, Vineet O'Reilly, Gerard Cameron, Peter Gupta, Amit Pandit, Amol P Soni, Kapil D Kaushik, Gaurav Mathew, Joseph Howard, Teresa Fahey, Madonna Stephenson, Michael Dharap, Satish Patel, Pankaj Thakor, Advait Sharma, Naveen Walker, Tony Misra, Mahesh C Gruen, Russell L Fitzgerald, Mark C BMJ Open Emergency Medicine OBJECTIVES: To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN: Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING: Major trauma centre in India. PARTICIPANTS: Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. INTERVENTION: A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. MAIN OUTCOME MEASURES: The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. RESULTS: Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). CONCLUSIONS: The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. TRIAL REGISTRATION NUMBER: NCT02877342. BMJ Publishing Group 2020-06-21 /pmc/articles/PMC7311027/ /pubmed/32565447 http://dx.doi.org/10.1136/bmjopen-2019-033236 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Emergency Medicine Mitra, Biswadev Kumar, Vineet O'Reilly, Gerard Cameron, Peter Gupta, Amit Pandit, Amol P Soni, Kapil D Kaushik, Gaurav Mathew, Joseph Howard, Teresa Fahey, Madonna Stephenson, Michael Dharap, Satish Patel, Pankaj Thakor, Advait Sharma, Naveen Walker, Tony Misra, Mahesh C Gruen, Russell L Fitzgerald, Mark C Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study |
title | Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study |
title_full | Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study |
title_fullStr | Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study |
title_full_unstemmed | Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study |
title_short | Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study |
title_sort | prehospital notification of injured patients presenting to a trauma centre in india: a prospective cohort study |
topic | Emergency Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311027/ https://www.ncbi.nlm.nih.gov/pubmed/32565447 http://dx.doi.org/10.1136/bmjopen-2019-033236 |
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