The association between regional guidelines compliance and mortality in severe trauma patients : an observational, retrospective study
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND AND IMPORTANCE: Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients.
OBJECTIVES: The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients.
DESIGN, SETTINGS AND PARTICIPANTS: We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items.
OUTCOME MEASURES AND ANALYSIS: The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24.
MAIN RESULTS: A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)].
CONCLUSION: Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
European journal of emergency medicine : official journal of the European Society for Emergency Medicine - 31(2024), 3 vom: 01. Apr., Seite 208-215 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Duclos, Gary [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 25.04.2024 Date Revised 25.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/MEJ.0000000000001122 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367561859 |
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| 100 | 1 | |a Duclos, Gary |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The association between regional guidelines compliance and mortality in severe trauma patients |b an observational, retrospective study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 25.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND AND IMPORTANCE: Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients | ||
| 520 | |a OBJECTIVES: The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients | ||
| 520 | |a DESIGN, SETTINGS AND PARTICIPANTS: We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items | ||
| 520 | |a OUTCOME MEASURES AND ANALYSIS: The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24 | ||
| 520 | |a MAIN RESULTS: A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)] | ||
| 520 | |a CONCLUSION: Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 700 | 1 | |a Heireche, Fouzia |e verfasserin |4 aut | |
| 700 | 1 | |a Siroutot, Manon |e verfasserin |4 aut | |
| 700 | 1 | |a Delamarre, Louis |e verfasserin |4 aut | |
| 700 | 1 | |a Sartorius, Max-Antoine |e verfasserin |4 aut | |
| 700 | 1 | |a Mergueditchian, Celine |e verfasserin |4 aut | |
| 700 | 1 | |a Velly, Lionel |e verfasserin |4 aut | |
| 700 | 1 | |a Carvelli, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a Bordais, Aurelia |e verfasserin |4 aut | |
| 700 | 1 | |a Pilarczyk, Estelle |e verfasserin |4 aut | |
| 700 | 1 | |a Leone, Marc |e verfasserin |4 aut | |
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