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Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada

BACKGROUND: Comparisons across trauma systems are key to identifying opportunities to improve trauma care. We aimed to compare trauma service structures, processes and outcomes between the English National Health Service (NHS) and the province of Quebec, Canada. METHODS: We conducted a multicentre c...

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Autores principales: Bouderba, Samy, Lecky, Fiona, Soltana, Kahina, Neveu, Xavier, Kumar, Dhushy Surendra, Bouamra, Omar, Coats, Timothy J., Tardif, Pier-Alexandre, Belcaid, Amina, Gonthier, Catherine, Moore, Lynne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CMA Impact Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854907/
https://www.ncbi.nlm.nih.gov/pubmed/36653031
http://dx.doi.org/10.1503/cjs.001822
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author Bouderba, Samy
Lecky, Fiona
Soltana, Kahina
Neveu, Xavier
Kumar, Dhushy Surendra
Bouamra, Omar
Coats, Timothy J.
Tardif, Pier-Alexandre
Belcaid, Amina
Gonthier, Catherine
Moore, Lynne
author_facet Bouderba, Samy
Lecky, Fiona
Soltana, Kahina
Neveu, Xavier
Kumar, Dhushy Surendra
Bouamra, Omar
Coats, Timothy J.
Tardif, Pier-Alexandre
Belcaid, Amina
Gonthier, Catherine
Moore, Lynne
author_sort Bouderba, Samy
collection PubMed
description BACKGROUND: Comparisons across trauma systems are key to identifying opportunities to improve trauma care. We aimed to compare trauma service structures, processes and outcomes between the English National Health Service (NHS) and the province of Quebec, Canada. METHODS: We conducted a multicentre cohort study including admissions of patients aged older than 15 years with major trauma to major trauma centres (MTCs) from 2014/15 to 2016/17. We compared structures descriptively, and time to MTC and time in the emergency department (ED) using Wilcoxon tests. We compared mortality, and hospital and intensive care unit (ICU) length of stay (LOS) using multilevel logistic regression with propensity score adjustment, stratified by body region of the worst injury. RESULTS: The sample comprised 36 337 patients from the NHS and 6484 patients from Quebec. Structural differences in the NHS included advanced prehospital medical teams (v. “scoop and run” in Quebec), helicopter transport (v. fixed-wing aircraft) and trauma team leaders. The median time to an MTC was shorter in Quebec than in the NHS for direct transports (1 h v. 1.5 h, p < 0.001) but longer for transfers (2.5 h v. 6 h, p < 0.001). Time in the ED was longer in Quebec than in the NHS (6.5 h v. 4.0 h, p < 0.001). The adjusted odds of death were higher in Quebec for head injury (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09–1.51) but lower for thoracoabdominal injuries (OR 0.69, 95% CI 0.52–0.90). The adjusted median hospital LOS was longer for spine, torso and extremity injuries in the NHS than in Quebec, and the median ICU LOS was longer for spine injuries. CONCLUSION: We observed significant differences in the structure of trauma care, delays in access and risk-adjusted outcomes between Quebec and the NHS. Future research should assess associations between structures, processes and outcomes to identify opportunities for quality improvement.
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spelling pubmed-98549072023-01-20 Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada Bouderba, Samy Lecky, Fiona Soltana, Kahina Neveu, Xavier Kumar, Dhushy Surendra Bouamra, Omar Coats, Timothy J. Tardif, Pier-Alexandre Belcaid, Amina Gonthier, Catherine Moore, Lynne Can J Surg Research BACKGROUND: Comparisons across trauma systems are key to identifying opportunities to improve trauma care. We aimed to compare trauma service structures, processes and outcomes between the English National Health Service (NHS) and the province of Quebec, Canada. METHODS: We conducted a multicentre cohort study including admissions of patients aged older than 15 years with major trauma to major trauma centres (MTCs) from 2014/15 to 2016/17. We compared structures descriptively, and time to MTC and time in the emergency department (ED) using Wilcoxon tests. We compared mortality, and hospital and intensive care unit (ICU) length of stay (LOS) using multilevel logistic regression with propensity score adjustment, stratified by body region of the worst injury. RESULTS: The sample comprised 36 337 patients from the NHS and 6484 patients from Quebec. Structural differences in the NHS included advanced prehospital medical teams (v. “scoop and run” in Quebec), helicopter transport (v. fixed-wing aircraft) and trauma team leaders. The median time to an MTC was shorter in Quebec than in the NHS for direct transports (1 h v. 1.5 h, p < 0.001) but longer for transfers (2.5 h v. 6 h, p < 0.001). Time in the ED was longer in Quebec than in the NHS (6.5 h v. 4.0 h, p < 0.001). The adjusted odds of death were higher in Quebec for head injury (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09–1.51) but lower for thoracoabdominal injuries (OR 0.69, 95% CI 0.52–0.90). The adjusted median hospital LOS was longer for spine, torso and extremity injuries in the NHS than in Quebec, and the median ICU LOS was longer for spine injuries. CONCLUSION: We observed significant differences in the structure of trauma care, delays in access and risk-adjusted outcomes between Quebec and the NHS. Future research should assess associations between structures, processes and outcomes to identify opportunities for quality improvement. CMA Impact Inc. 2023-01-18 /pmc/articles/PMC9854907/ /pubmed/36653031 http://dx.doi.org/10.1503/cjs.001822 Text en © 2023 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Research
Bouderba, Samy
Lecky, Fiona
Soltana, Kahina
Neveu, Xavier
Kumar, Dhushy Surendra
Bouamra, Omar
Coats, Timothy J.
Tardif, Pier-Alexandre
Belcaid, Amina
Gonthier, Catherine
Moore, Lynne
Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
title Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
title_full Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
title_fullStr Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
title_full_unstemmed Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
title_short Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
title_sort comparison of trauma care structures, processes and outcomes between the english national health service and quebec, canada
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854907/
https://www.ncbi.nlm.nih.gov/pubmed/36653031
http://dx.doi.org/10.1503/cjs.001822
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