A quality-improvement approach to effective trauma team activation.

Background: Appropriate, timely trauma team activation (TTA) can directly affect outcomes for patients with trauma. A review of quality-performance indicators at our Canadian level 1 trauma centre showed a high level of undertriage, with TTA compliance rates less than 60% for major trauma. A quality-improvement project was undertaken, targeting a sustained goal of at least 90% TTA compliance based on Accreditation Canada guidelines.

High-risk medications in older patients with trauma: a cross-sectional study of risk mitigation.

Background: The Beers Criteria for Potentially Inappropriate Medication Use inOlder Adults is a framework that can assess the nature of high-risk medication use. The objective of this study was to use the Beers Criteria to assess the prevalence and nature of polypharmacy, the magnitude of medication changes during the hospital stay and the impact of Beers Criteria medications on outcomes in older patients with trauma.

Methods: We used the Alberta Trauma Registry to conduct a retrospective review of patients aged 65 years or older with major trauma (Injury Severity Score ≥ 12) who were admitted to a level 1 trauma centre between January 2013 and December 2014.

Ensuring adequate vascular access in patients with major trauma: a quality improvement initiative.

Ensuring adequate vascular access in major trauma patients prior to decompensative physiological processes is crucial to patient outcomes. Most protocols suggest achieving two 18-gauge or larger intravenous lines immediately in patients with major trauma. We discuss a quality improvement approach to ensure that >90% of patients with major trauma (as defined by an injury severity score ≥12) at a level one trauma centre receive timely and adequate fluid access.

Facility-Level Factors and Outcomes After Skilled Nursing Facility Admission for Trauma and Surgical Patients.

Objective: Patients discharged to skilled nursing facilities (SNFs) have worse outcomes than those discharged to home, but whether this is due to differences in facility-level factors in addition to patient characteristics is not known. We aimed to determine whether SNF-level factors including nurse staffing and patient density are associated with outcomes after acute hospitalization for trauma or surgery.

Design, Setting, Participants, And Measurements: Retrospective study of patients discharged to Medicare-certified SNFs after trauma or major surgery from 2007 to 2009.

Intentional injury and violence in Cape Town, South Africa: an epidemiological analysis of trauma admissions data.

Background: Injury is a truly global health issue that has enormous societal and economic consequences in all countries. Interpersonal violence is now widely recognized as important global public health issues that can be addressed through evidence-based interventions. In South Africa, as in many low- and middle-income countries (LMIC), a lack of ongoing, systematic injury surveillance has limited the ability to characterize the burden of violence-related injury and to develop prevention programmes.

Temporal trends in surgical intervention for severe traumatic brain injury caused by extra-axial hemorrhage, 1995 to 2012.

Background: Surgical intervention for severe traumatic brain injury (TBI) caused by extra-axial hemorrhage has declined in recent decades. The effect of this change on patient outcomes is unknown.

Objective: To determine the change over time in surgical intervention in this population and to assess changes in patient outcomes.

Risk factors for unplanned readmissions in older adult trauma patients in Washington State: a competing risk analysis.

Background: Hospital readmission is a significant contributor to increasing health care use related to caring for older trauma patients. This study was undertaken with the following aims: determine the proportion of older adult trauma patients who experience unplanned readmission, as well as risk factors for these readmissions and identify the most common readmission diagnoses among these patients.

Study Design: We conducted a retrospective cohort study of trauma patients age 55 years and older who survived their hospitalization at a statewide trauma center between 2009 and 2010.

Pre-hospital aspiration is associated with increased pulmonary complications.

Background: Rates of ventilator-associated pneumonia (VAP) are highest among patients intubated on an emergency basis following trauma. We reported previously a retrospective analysis demonstrating an association between subjective aspiration and VAP after pre-hospital intubation. We hypothesize that by directing paramedics to note features of aspiration at intubation, we will confirm prospectively the association between pre-hospital aspiration and subsequent pneumonia in trauma patients.

Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions.

Importance: Trauma is a leading cause of death and disability worldwide. In many low- and middle-income countries, formal trauma surveillance strategies have not yet been widely implemented.

Objective: To formalize injury data collection at Groote Schuur Hospital, the chief academic hospital of the University of Cape Town, a level I trauma center, and one of the largest trauma referral hospitals in the world.

Collecting injury surveillance data in low- and middle-income countries: the Cape Town Trauma Registry pilot.

Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data.