6 research outputs found

    Do male and female trauma patients receive the same prehospital care? : An observational follow-up study

    Get PDF
    Background: Trauma-related mortality can be lowered by efficient prehospital care. Less is known about whether gender influences the prehospital trauma care provided. The aim of this study was to explore gender-related differences in prehospital trauma care of severely injured trauma patients, with a special focus on triage, transportation, and interventions. Methods: We performed a retrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County, Sweden. A total of 383 trauma patients (279 males and 104 females) > 15years of age with an Injury Severity Score (ISS) of > 15 transported to emergency care hospitals in the Stockholm area were included. Results: Male patients had a 2.75 higher odds ratio (95% CI, 1.2-6.2) for receiving the highest prehospital priority compared to females on controlling for injury mechanism and vital signs on scene. No significant difference between genders was detected regarding other aspects of the prehospital care provided. Conclusions: This study indicated that prehospital prioritization among severely injured late adolescent and adult trauma patients differs between genders. Knowledge of a more diffuse presentation of symptoms in female trauma patients despite severe injury may help to adapt and improve prehospital trauma care for this group.Peer reviewe

    Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations

    Get PDF
    Background: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. Methods: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. Results: The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients' tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P=0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P=0.03). Conclusions: When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications.Peer reviewe

    Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

    No full text
    Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89路6 per cent) compared with that in countries with a middle (753 of 1242, 60路6 per cent; odds ratio (OR) 0路17, 95 per cent c.i. 0路14 to 0路21, P < 0路001) or low (363 of 860, 42路2 per cent; OR 0路08, 0路07 to 0路10, P < 0路001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9路4 (95 per cent c.i. -11路9 to -6路9) per cent; P < 0路001), but the relationship was reversed in low-HDI countries (+12路1 (+7路0 to +17路3) per cent; P < 0路001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0路60, 0路50 to 0路73; P < 0路001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

    Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

    No full text
    Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6路9 per cent) from low-HDI, 254 (15路5 per cent) from middle-HDI and 1268 (77路6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57路5, 40路9 and 35路4 per cent; P < 0路001) and subsequent use of end colostomy (52路2, 24路8 and 18路9 per cent; P < 0路001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3路20, 95 per cent c.i. 1路35 to 7路57; P = 0路008) after risk adjustment for malignant disease (OR 2路34, 1路65 to 3路32; P < 0路001), emergency surgery (OR 4路08, 2路73 to 6路10; P < 0路001), time to operation at least 48 h (OR 1路99, 1路28 to 3路09; P = 0路002) and disease perforation (OR 4路00, 2路81 to 5路69; P < 0路001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone
    corecore