Dataset Information

Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study.

ABSTRACT:

Background

The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management.

Methods

Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs.

Results

We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care.

Conclusions

We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit.

Trial registration

Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.

SUBMITTER: Peterer L

PROVIDER: S-EPMC6923826 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Publications

Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study.

Peterer Lorenz L Ossendorf Christian C Jensen Kai Oliver KO Osterhoff Georg G Mica Ladislav L Seifert Burkhardt B Werner Clément M L CML Simmen Hans-Peter HP Pape Hans-Christoph HC Sprengel Kai K

BMC geriatrics 20191219 1

<h4>Background</h4>The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced ...[more]

PMID: 31856739

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Project description:IntroductionImprovements in life expectancy imply that an increase of geriatric trauma patients occurs. These patients require special attention due to their multiple comorbidity issues. The aim of this study was to assess the impact of the implementation of geriatric comanagement (GC) on the allocation and clinical outcome of geriatric trauma patients.MethodsThis observational cohort study aims to compare the demographic development and the clinical outcome in geriatric trauma patients (aged 70 years and older) before and after implementation of a certified geriatric trauma center (GC). Geriatric trauma patients admitted between January 1, 2010 and December 31, 2010 were stratified to group pre-GC and admissions between January 1, 2018 and December 31, 2018 to Group post-GC. We excluded patients requiring end-of-life treatment and those who died within 24 h or due to severe traumatic brain injury. Outcome parameters included demographic changes, medical complexity (measured by American Society of Anaesthesiology Score (ASA) and Charlson Comorbidity Index (CCI)), in-hospital mortality and length of hospitalization.ResultsThis study includes 626 patients in Group pre-GC (mean age 80.3 ± 6.7 years) and 841 patients in Group post-GC (mean age 81.1 ± 7.3 years). Group pre-GC included 244 (39.0%) males, group post-GC included 361 (42.9%) males. The mean CCI was 4.7 (± 1.8) points in pre-GC and 5.1 (± 2.0) points in post-GC (p <0.001). In Group pre-GC, 100 patients (16.0%) were stratified as ASA 1 compared with 47 patients (5.6%) in Group post-GC (p <0.001). Group pre-GC had significantly less patients stratified as ASA 3 or higher (n = 235, 37.5%) compared with Group post-GC (n = 389, 46.3%, p <0.001). Length of stay (LOS) decreased significantly from 10.4 (± 20.3) days in Group pre-GC to 7.9 (±22.9) days in Group post-GC (p = 0.011). The 30-day mortality rate was comparable amongst these groups (pre-GC 8.8% vs. post-GC 8.9%).ConclusionThis study appears to support the implementation of a geriatric trauma center, as certain improvements in the patient care were found: Despite a higher CCI and a higher number of patients with higher ASA classifications, Hospital LOS, complication rates and mortality did were not increased after implementation of the CG. The increase in the case numbers supports the fact that a higher degree of specialization leads to a response by admitting physicians, as it exceeded the expectable trend of demographic ageing. We feel that a larger data base, hopefully in a multi center set up should be undertaken to verify these results.

Project description:BackgroundInterventions for insomnia that also address autonomic dysfunction are needed.ObjectiveWe evaluate Cereset Research™ Standard Operating Procedures (CR-SOP) in a pilot randomized, controlled trial. CR-SOP is a less operator-dependent, more generalizable innovation of HIRREM®, a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology demonstrated to improve insomnia and autonomic function.MethodsAdults with Insomnia Severity Index (ISI) scores of ≥8 were randomized to receive ten sessions of CR-SOP, with tones linked to brainwaves (LB, intervention), or a sham condition of random tones not linked to brainwaves (NL, control). Measures were collected at enrollment and 0-14 days and 4-6 weeks post-allocated intervention. The primary outcome was differential change in ISI from baseline to 4-6 weeks post-intervention. Secondary self-report measures assessed sleep quality65 and behavioral outcomes. Ten-minute recordings of heart rate and blood pressure were collected to analyze autonomic function (heart rate variability [HRV] and baroreflex sensitivity).ResultsOf 22 randomized, 20 participants completed the allocated condition. Intention to treat analysis of change from baseline to the 4-6 week outcome demonstrated mean ISI score reduction of 4.69 points among controls (SE 1.40). In the intervention group, there was an additional 2.58 point reduction in ISI score (SE 2.13; total reduction of 7.27, P = .24). Sleep quality and some measures of autonomic function improved significantly among the intervention group compared to control.ConclusionsThis pilot study compared use of a standardized, allostatic, acoustic neurotechnology intervention with a sham, active control condition. The magnitude of change in insomnia severity was clinically relevant and similar to the findings in a prior, fully powered trial, but the differential improvement observed was not statistically significant. Significant improvements were demonstrated in sleep quality and some autonomic function measures.

Project description:ObjectivesOur understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets.DesignInformation collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data.Setting60-bed academic level I trauma adult ED in a large Midwestern city.Participants2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed.Main outcome measuresMain outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics.ResultsMost ED nurses believed that information collection aligned with the hospital's mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year.ConclusionsIt is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.

Dataset Information

Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study.

Background

Methods

Results

Conclusions

Trial registration

Publications

Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study.

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