Definitive care in level 3 trauma centres after severe injury: A comparison of clinical characteristics and outcomes.

Background: The role of level 3 trauma centres (TC) in inclusive trauma systems has not been well defined. The absence of nationally recognised inter-facility transfer criteria for inclusive systems has often left individual level 3 TCs to decide upon their own what their spectrum of care is and particularly which severely injured patients to admit for definitive care.

Methods: Retrospective cohort study in which the principal objective was to compare the characteristics and outcomes of severely injured (injury severity score>15) adult patients (≥18 years) who received definitive care at level 3 centres with severely injured adult patients who were transferred to level 1-2 TCs during the same time period.

Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program.

Background: Massive transfusion protocols (MTPs) have been developed to implement damage control resuscitation (DCR) principles. A survey of MTP policies from American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) participants was performed to establish which MTP activation, hemostatic resuscitation, and monitoring aspects of DCR are included in the MTP guidelines.

Methods: On October 10, 2013, ACS-TQIP administration administered a cross-sectional electronic survey to 187 ACS-TQIP participants.

Trial of short-course antimicrobial therapy for intraabdominal infection.

Background: The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.

Methods: We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days.

Close to home: an analysis of the relationship between location of residence and location of injury.

Background: Injury surveillance is critical in identifying the need for targeted prevention initiatives. Understanding the geographic distribution of injuries facilitates matching prevention programs with the population most likely to benefit. At the population level, however, the geographic site of injury is rarely known, leading to the use of location of residence as a surrogate.

Exploring the characteristics of high-performing hospitals that influence trauma triage and transfer.

Background: Many trauma patients might be first cared for at nondesignated centers before transfer to a trauma center. Limited research has investigated determinants of timely triage and transfer to identify those amenable to quality improvement. This study explored factors influencing timely triage and transfer in a regional trauma system.

Optimizing inter-professional communications in surgery: protocol for a mixed-methods exploratory study.

Background: Effective nurse-physician communication is critical to delivering high quality patient care. Interprofessional communication between surgical nurses and surgeons, often through the use of pagers, is currently characterized by information gaps and interprofessional tensions, both sources of workflow interruption, potential medical error, impaired educational experience, and job satisfaction.

Objective: This study aims to define current patterns of, and understand enablers and barriers to interprofessional communication in general surgery, in order to optimize the use of communication technologies, teamwork, provider satisfaction, and quality and safety of patient care.

A geospatial analysis of the relationship between neighbourhood socioeconomic status and adult severe injury in Greater Vancouver.

Background: Every year, injuries cost the Canadian healthcare system billions of dollars and result in thousands of emergency room visits, hospitalisations and deaths. The purpose of this study was to explore the relationship between neighbourhood socioeconomic status (NSES) and the rates of all-cause, unintentional and intentional severe injury in Greater Vancouver adults. A second objective was to determine whether the identified associations were spatially consistent or non-stationary.

Morbidity and survival probability in burn patients in modern burn care.

Objective: Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn.

Establishing components of high-quality injury care: Focus groups with patients and patient families.

Background: Each year, injuries affect 700 million people worldwide, more than 5 million people die of injuries, and 68,000 survivors remain permanently impaired. Half of all critically injured patients do not receive recommended care, and medical errors are common. Little is known about the aspects of injury care that are important to patients and their families.

Barriers to implementing the World Health Organization's Trauma Care Checklist: A Canadian single-center experience.

Background: Management of trauma patients is difficult because of their complexity and acuity. In an effort to improve patient care and reduce morbidity and mortality, the World Health Organization developed a trauma care checklist. Local stakeholder input led to a modified 16-item version that was subsequently piloted.

Compliance with a massive transfusion protocol (MTP) impacts patient outcome.

Background: About 5% of civilian trauma requires massive transfusion. Protocolized resuscitation with blood products to achieve high plasma:RBC ratio has been advocated to improve survival. Our objectives were to measure compliance to our institutional MTP, to identify quality assurance activities that could improve protocol compliance and to determine if protocol compliance was related to patient outcome.

Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis.

Background: There is increasing evidence to support the use of percutaneous abscess drainage, laparoscopy, and primary anastomosis in managing acute diverticulitis.

Objective: The aim of this study was to evaluate how practices have evolved and to determine the effects on clinical outcomes.

Design: This is a population-based retrospective cohort study using administrative discharge data.

Comparative study of outcome measures and analysis methods for traumatic brain injury trials.

Batteries of functional and cognitive measures have been proposed as alternatives to the Extended Glasgow Outcome Scale (GOSE) as the primary outcome for traumatic brain injury (TBI) trials. We evaluated several approaches to analyzing GOSE and a battery of four functional and cognitive measures. Using data from a randomized trial, we created a "super" dataset of 16,550 subjects from patients with complete data (n=331) and then simulated multiple treatment effects across multiple outcome measures.

Temporal trends and differences in mortality at trauma centres across Ontario from 2005 to 2011: a retrospective cohort study.

Background: Care in a trauma centre is associated with significant reductions in mortality after severe injury. However, emerging evidence suggests that outcomes across similarly accredited trauma centres are not equivalent, even after adjusting for case-mix. The primary objective of this analysis was to evaluate secular trends in overall mortality at trauma centres.

Trauma Non-Technical Training (TNT-2): the development, piloting and multilevel assessment of a simulation-based, interprofessional curriculum for team-based trauma resuscitation.

Medical error is common during trauma resuscitations. Most errors are nontechnical, stemming from ineffective team leadership, nonstandardized communication among team members, lack of global situational awareness, poor use of resources and inappropriate triage and prioritization. We developed an interprofessional, simulation-based trauma team training curriculum for Canadian surgical trainees.

Age-related trends in severe injury hospitalization in Canada.

Background: We performed a population-based evaluation of age-related trends in severe injury hospitalization across Canada.

Methods: We identified hospitalizations following severe injury (Injury Severity Score [ISS] > 15) between 2002 and 2009 using the Canadian National Trauma Registry. Age-standardized severe injury hospitalization rates were calculated using the direct method referencing the 2006 Canadian population.

The Trauma Center Organizational Culture Survey: development and conduction.

Background: The Trauma Center Organizational Culture Survey (TRACCS) instrument was developed to assess organizational culture of trauma centers enrolled in the American College of Surgeons Trauma Quality Program (ACS TQIP). The objective is to provide evidence on the psychometric properties of the factors of TRACCS and describe the current organizational culture of TQIP-enrolled trauma centers.

Methods: A cross-sectional study was conducted by surveying a sampling of employees at 174 TQIP-enrolled trauma centers.

Risk of readmission and emergency surgery following nonoperative management of colonic diverticulitis: a population-based analysis.

Objective: To characterize the clinical course of patients with diverticulitis after nonoperative management and determine factors associated with readmission and subsequent emergency surgery.

Background: Clinical course of this disease remains poorly understood; indications for elective colectomy are unclear.

Methods: This was a retrospective cohort study of patients managed nonoperatively after a first episode of diverticulitis in Ontario, Canada (2002-2012).

Economic evaluation of decompressive craniectomy versus barbiturate coma for refractory intracranial hypertension following traumatic brain injury.

Objectives: Decompressive craniectomy and barbiturate coma are often used as second-tier strategies when intracranial hypertension following severe traumatic brain injury is refractory to first-line treatments. Uncertainty surrounds the decision to choose either treatment option. We investigated which strategy is more economically attractive in this context.

Public bicycle share programs and head injuries.

Objectives: We evaluated the effect of North American public bicycle share programs (PBSPs), which typically do not offer helmets with rentals, on the occurrence of bicycle-related head injuries.

Methods: We analyzed trauma center data for bicycle-related injuries from 5 cities with PBSPs and 5 comparison cities. We used logistic regression models to compare the odds that admission for a bicycle-related injury would involve a head injury 24 months before PBSP implementation and 12 months afterward.

An inventory of Canadian trauma systems: opportunities for improving access to trauma care.

Objective: Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care.

Methods: We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components.

Derivation and validation of a quality indicator for 30-day unplanned hospital readmission to evaluate trauma care.

Background: Unplanned readmissions represent 20% of all admissions and cost $12 billion annually in the United States. Despite the burden of injuries for the health care system, no quality indicator (QI) based on readmissions is available to evaluate trauma care. The objective of this study was to derive and internally validate a QI for a 30-day unplanned hospital readmission to evaluate trauma care.

Derivation and validation of a quality indicator of acute care length of stay to evaluate trauma care.

Objective: To derive and internally validate a quality indicator (QI) for acute care length of stay (LOS) after admission for injury.

Background: Unnecessary hospital days represent an estimated 20% of total LOS implying an important waste of resources as well as increased patient exposure to hospital-acquired infections and functional decline.

Methods: This study is based on a multicenter, retrospective cohort from a Canadian provincial trauma system (2005-2010; 57 trauma centers; n = 57,524).

Feasibility and transport of packed red blood cells into Special Forces operational conditions.

Background: Transfusing packed red blood cells (PRBCs) into Special Forces may provide a survival advantage from hemorrhage-induced battlefield injuries; however, the effect of the unique operational stressors on RBC integrity is not known.

Methods: Pooled PRBCs (20 U) (7 days old), stored in Golden Hour containers, were exposed to the following simulated operational stressors: High-Altitude Low-Opening parachute descent from 30,000 ft, followed by a simulated soldier presence patrol in a climatic chamber set to 48 °C and 9% humidity for 12 hours (test). Biochemical (pH, lactate, potassium, and adenosine triphosphate) and biomechanical (percent hemolysis, deformability, and morphology) were measured to determine the integrity of PRBCs.

Hospital length of stay after admission for traumatic injury in Canada: a multicenter cohort study.

Objective: To describe acute care length of stay (LOS) over all consecutive hospitalizations for the injury and according to level of care [intensive care unit (ICU), intermediate care, general ward], compare observed and expected LOS, and identify predictors of LOS.

Background: Prolonged LOS has important consequences in terms of costs and outcome, yet detailed information on LOS after trauma is lacking.

Methods: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian trauma system (1999-2010; n = 126,513).