A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country.
Identifieur interne : 001E53 ( PubMed/Corpus ); précédent : 001E52; suivant : 001E54A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country.
Auteurs : Matthew R. Kesinger ; Lisa R. Nagy ; Denisse J. Sequeira ; Jose D. Charry ; Juan C. Puyana ; Andres M. RubianoSource :
- Injury [ 1879-0267 ] ; 2014.
English descriptors
- KwdEn :
- Adult, Brain Injuries (mortality), Brain Injuries (therapy), Clinical Protocols, Female, Glasgow Coma Scale, Hospital Mortality (trends), Hospitals, Teaching (organization & administration), Humans, Length of Stay (trends), Male, Middle Aged, Organizational Innovation, Practice Guidelines as Topic, Primary Health Care (organization & administration), Primary Health Care (standards), Quality Improvement (organization & administration), Reference Standards, Trauma Centers (organization & administration), Trauma Severity Indices, United States (epidemiology).
- MESH :
- geographic , epidemiology : United States.
- mortality : Brain Injuries.
- organization & administration : Hospitals, Teaching, Primary Health Care, Quality Improvement, Trauma Centers.
- standards : Primary Health Care.
- therapy : Brain Injuries.
- trends : Hospital Mortality, Length of Stay.
- Adult, Clinical Protocols, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Organizational Innovation, Practice Guidelines as Topic, Reference Standards, Trauma Severity Indices.
Abstract
Standardized trauma protocols (STP) have reduced morbidity and in-hospital mortality in mature trauma systems. Most hospitals in low- and middle-income countries (LMICs) have not implemented STPs, often because of financial and logistic limitations. We report the impact of an STP designed for the care of trauma patients in the emergency department (ED) at an LMIC hospital on patients with severe traumatic brain injury (STBI).
DOI: 10.1016/j.injury.2014.04.037
PubMed: 24861416
Links to Exploration step
pubmed:24861416Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country.</title><author><name sortKey="Kesinger, Matthew R" sort="Kesinger, Matthew R" uniqKey="Kesinger M" first="Matthew R" last="Kesinger">Matthew R. Kesinger</name><affiliation><nlm:affiliation>University of Pittsburgh School of Medicine, United States. Electronic address: kesingermr2@upmc.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Nagy, Lisa R" sort="Nagy, Lisa R" uniqKey="Nagy L" first="Lisa R" last="Nagy">Lisa R. Nagy</name><affiliation><nlm:affiliation>University of Pittsburgh School of Nursing, United States. Electronic address: lisarnagy7@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Sequeira, Denisse J" sort="Sequeira, Denisse J" uniqKey="Sequeira D" first="Denisse J" last="Sequeira">Denisse J. Sequeira</name><affiliation><nlm:affiliation>University of Pittsburgh, United States. Electronic address: Des103@pitt.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Charry, Jose D" sort="Charry, Jose D" uniqKey="Charry J" first="Jose D" last="Charry">Jose D. Charry</name><affiliation><nlm:affiliation>Universidad Surcolombiana, Colombia. Electronic address: danielcharry06@hotmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Puyana, Juan C" sort="Puyana, Juan C" uniqKey="Puyana J" first="Juan C" last="Puyana">Juan C. Puyana</name><affiliation><nlm:affiliation>University of Pittsburgh School of Nursing, United States. Electronic address: puyajc@upmc.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Rubiano, Andres M" sort="Rubiano, Andres M" uniqKey="Rubiano A" first="Andres M" last="Rubiano">Andres M. Rubiano</name><affiliation><nlm:affiliation>Universidad Surcolombiana, Colombia. Electronic address: rubianoam@gmail.com.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24861416</idno><idno type="pmid">24861416</idno><idno type="doi">10.1016/j.injury.2014.04.037</idno><idno type="wicri:Area/PubMed/Corpus">001E53</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001E53</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country.</title><author><name sortKey="Kesinger, Matthew R" sort="Kesinger, Matthew R" uniqKey="Kesinger M" first="Matthew R" last="Kesinger">Matthew R. Kesinger</name><affiliation><nlm:affiliation>University of Pittsburgh School of Medicine, United States. Electronic address: kesingermr2@upmc.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Nagy, Lisa R" sort="Nagy, Lisa R" uniqKey="Nagy L" first="Lisa R" last="Nagy">Lisa R. Nagy</name><affiliation><nlm:affiliation>University of Pittsburgh School of Nursing, United States. Electronic address: lisarnagy7@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Sequeira, Denisse J" sort="Sequeira, Denisse J" uniqKey="Sequeira D" first="Denisse J" last="Sequeira">Denisse J. Sequeira</name><affiliation><nlm:affiliation>University of Pittsburgh, United States. Electronic address: Des103@pitt.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Charry, Jose D" sort="Charry, Jose D" uniqKey="Charry J" first="Jose D" last="Charry">Jose D. Charry</name><affiliation><nlm:affiliation>Universidad Surcolombiana, Colombia. Electronic address: danielcharry06@hotmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Puyana, Juan C" sort="Puyana, Juan C" uniqKey="Puyana J" first="Juan C" last="Puyana">Juan C. Puyana</name><affiliation><nlm:affiliation>University of Pittsburgh School of Nursing, United States. Electronic address: puyajc@upmc.edu.</nlm:affiliation></affiliation></author><author><name sortKey="Rubiano, Andres M" sort="Rubiano, Andres M" uniqKey="Rubiano A" first="Andres M" last="Rubiano">Andres M. Rubiano</name><affiliation><nlm:affiliation>Universidad Surcolombiana, Colombia. Electronic address: rubianoam@gmail.com.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Injury</title><idno type="eISSN">1879-0267</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Brain Injuries (mortality)</term><term>Brain Injuries (therapy)</term><term>Clinical Protocols</term><term>Female</term><term>Glasgow Coma Scale</term><term>Hospital Mortality (trends)</term><term>Hospitals, Teaching (organization & administration)</term><term>Humans</term><term>Length of Stay (trends)</term><term>Male</term><term>Middle Aged</term><term>Organizational Innovation</term><term>Practice Guidelines as Topic</term><term>Primary Health Care (organization & administration)</term><term>Primary Health Care (standards)</term><term>Quality Improvement (organization & administration)</term><term>Reference Standards</term><term>Trauma Centers (organization & administration)</term><term>Trauma Severity Indices</term><term>United States (epidemiology)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Brain Injuries</term></keywords><keywords scheme="MESH" qualifier="organization & administration" xml:lang="en"><term>Hospitals, Teaching</term><term>Primary Health Care</term><term>Quality Improvement</term><term>Trauma Centers</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Primary Health Care</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Brain Injuries</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Hospital Mortality</term><term>Length of Stay</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Clinical Protocols</term><term>Female</term><term>Glasgow Coma Scale</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Organizational Innovation</term><term>Practice Guidelines as Topic</term><term>Reference Standards</term><term>Trauma Severity Indices</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Standardized trauma protocols (STP) have reduced morbidity and in-hospital mortality in mature trauma systems. Most hospitals in low- and middle-income countries (LMICs) have not implemented STPs, often because of financial and logistic limitations. We report the impact of an STP designed for the care of trauma patients in the emergency department (ED) at an LMIC hospital on patients with severe traumatic brain injury (STBI).</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24861416</PMID><DateCreated><Year>2014</Year><Month>08</Month><Day>06</Day></DateCreated><DateCompleted><Year>2015</Year><Month>05</Month><Day>14</Day></DateCompleted><DateRevised><Year>2016</Year><Month>10</Month><Day>25</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1879-0267</ISSN><JournalIssue CitedMedium="Internet"><Volume>45</Volume><Issue>9</Issue><PubDate><Year>2014</Year><Month>Sep</Month></PubDate></JournalIssue><Title>Injury</Title><ISOAbbreviation>Injury</ISOAbbreviation></Journal><ArticleTitle>A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country.</ArticleTitle><Pagination><MedlinePgn>1350-4</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.injury.2014.04.037</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0020-1383(14)00204-6</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Standardized trauma protocols (STP) have reduced morbidity and in-hospital mortality in mature trauma systems. Most hospitals in low- and middle-income countries (LMICs) have not implemented STPs, often because of financial and logistic limitations. We report the impact of an STP designed for the care of trauma patients in the emergency department (ED) at an LMIC hospital on patients with severe traumatic brain injury (STBI).</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">We developed an STP based on generally accepted best practices and damage control resuscitation for a level I trauma centre in Colombia. Without a pre-existing trauma registry, we adapted an administrative electronic database to capture clinical information of adult patients with TBI, a head abbreviated injury score (AIS) ≥3, and who presented ≤12h from injury. Demographics, mechanisms of injury, and injury severity were compared. Primary outcome was in-hospital mortality. Secondary outcomes were Glasgow Coma Score (GCS), length of hospital and ICU stay, and prevalence of ED interventions recommended in the STP. Logistic regression was used to control for potential confounders.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The pre-STP group was hospitalized between August 2010 and August 2011, the post-STP group between September 2011 and June 2012. There were 108 patients meeting inclusion criteria, 68 pre-STP implementation and 40 post-STP. The pre- and post-STP groups were similar in age (mean 37.1 vs. 38.6, p=0.644), head AIS (median 4.5 vs. 4.0, p=0.857), Injury Severity Scale (median 25 vs. 25, p=0.757), and initial GCS (median 7 vs. 7, p=0.384). Post-STP in-hospital mortality decreased (38% vs. 18%, p=0.024), and discharge GCS increased (median 10 vs. 14, p=0.034). After controlling for potential confounders, odds of in-hospital mortality post-STP compared to pre-STP were 0.248 (95%CI: 0.074-0.838, p=0.025). Hospital and ICU stay did not significantly change. The use of many ED interventions increased post-STP, including bladder catheterization (49% vs. 73%, p=0.015), hypertonic saline (38% vs. 63%, p=0.014), arterial blood gas draws (25% vs. 43%, p=0.059), and blood transfusions (3% vs. 18%, p=0.008).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">An STP in an LMIC decreased in-hospital mortality, increased discharge GCS, and increased use of vital ED interventions for patients with STBI. An STP in an LMIC can be implemented and measured without a pre-existing trauma registry.</AbstractText><CopyrightInformation>Copyright © 2014 Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kesinger</LastName><ForeName>Matthew R</ForeName><Initials>MR</Initials><AffiliationInfo><Affiliation>University of Pittsburgh School of Medicine, United States. Electronic address: kesingermr2@upmc.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nagy</LastName><ForeName>Lisa R</ForeName><Initials>LR</Initials><AffiliationInfo><Affiliation>University of Pittsburgh School of Nursing, United States. Electronic address: lisarnagy7@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sequeira</LastName><ForeName>Denisse J</ForeName><Initials>DJ</Initials><AffiliationInfo><Affiliation>University of Pittsburgh, United States. Electronic address: Des103@pitt.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Charry</LastName><ForeName>Jose D</ForeName><Initials>JD</Initials><AffiliationInfo><Affiliation>Universidad Surcolombiana, Colombia. Electronic address: danielcharry06@hotmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Puyana</LastName><ForeName>Juan C</ForeName><Initials>JC</Initials><AffiliationInfo><Affiliation>University of Pittsburgh School of Nursing, United States. Electronic address: puyajc@upmc.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rubiano</LastName><ForeName>Andres M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>Universidad Surcolombiana, Colombia. Electronic address: rubianoam@gmail.com.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>R21 TW009332</GrantID><Acronym>TW</Acronym><Agency>FIC NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2014</Year><Month>04</Month><Day>28</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Injury</MedlineTA><NlmUniqueID>0226040</NlmUniqueID><ISSNLinking>0020-1383</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001930" MajorTopicYN="N">Brain Injuries</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002985" MajorTopicYN="N">Clinical Protocols</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015600" MajorTopicYN="N">Glasgow Coma Scale</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName><QualifierName UI="Q000639" MajorTopicYN="Y">trends</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006784" MajorTopicYN="N">Hospitals, Teaching</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="N">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007902" MajorTopicYN="N">Length of Stay</DescriptorName><QualifierName UI="Q000639" MajorTopicYN="Y">trends</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009936" MajorTopicYN="N">Organizational Innovation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017410" MajorTopicYN="N">Practice Guidelines as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011320" MajorTopicYN="N">Primary Health Care</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058996" MajorTopicYN="N">Quality Improvement</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012015" MajorTopicYN="N">Reference Standards</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014193" MajorTopicYN="N">Trauma Centers</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015599" MajorTopicYN="N">Trauma Severity Indices</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Outcomes</Keyword><Keyword MajorTopicYN="N">Quality improvement in LMIC</Keyword><Keyword MajorTopicYN="N">Severe TBI</Keyword><Keyword MajorTopicYN="N">Trauma</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2013</Year><Month>11</Month><Day>06</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2014</Year><Month>04</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2014</Year><Month>04</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>5</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>5</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2015</Year><Month>5</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">24861416</ArticleId><ArticleId IdType="pii">S0020-1383(14)00204-6</ArticleId><ArticleId IdType="doi">10.1016/j.injury.2014.04.037</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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