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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes.

ABSTRACT: Background: Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation.

Main body: We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as "in-hospital mortality" as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure.

Conclusion: The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7?days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.

SUBMITTER: Bedard AF

PROVIDER: S-EPMC7724615 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes.

Bedard Alexander F AF Mata Lina V LV Dymond Chelsea C Moreira Fabio F Dixon Julia J Schauer Steven G SG Ginde Adit A AA Bebarta Vikhyat V Moore Ernest E EE Mould-Millman Nee-Kofi NK

International journal of emergency medicine 20201209 1

<h4>Background</h4>Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation.<h4>Main body ...[more]

PMID: 33297951

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Project description:Context and objectivesNeighbourhood effect research on obesity took off in the early 2000s and was composed of mostly cross-sectional observational studies interested in various characteristics of the built environment and the socioeconomic environment. To limit biases related to self-selection and life course exposures, many researchers apply longitudinal designs in their studies. Until now, no review has specifically and exclusively examined longitudinal studies and the specific designs of these studies. In this review, we intend to answer the following research question: how are the temporal measurements of contextual exposure and obesity outcomes integrated into longitudinal studies that explore how neighbourhood-level built and socioeconomic environments impact adult obesity?DesignA systematic search strategy was designed to address the research question. The search was performed in Embase, Web of Science and PubMed, targeting scientific papers published before 1 January 2018. The eligible studies reported results on adults, included exposure that was limited to neighbourhood characteristics at the submunicipal level, included an outcome limited to obesity proxies, and reported a design with at least two exposure measurements or two outcome measurements.ResultsThis scoping review identified 66 studies that fit the eligibility criteria. A wide variety of neighbourhood characteristics were also measured, making it difficult to draw general conclusions about associations between neighbourhood exposure and obesity. We applied a typology that classified studies by whether exposure and outcome were measured as varying or fixed. Using this typology, we found that 32 studies reported both neighbourhood exposure and obesity outcomes that were varying in time; 28 reported varying outcomes but fixed exposures; and 6 had fixed outcomes and varying exposures.ConclusionOur typology illustrates the variety of longitudinal designs that were used in the selected studies. In the light of our results, we make recommendations on how to better report longitudinal designs and facilitate comparisons between studies.

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Project description:IntroductionPrehospital haemorrhage control has saved thousands of lives in the military over the last decade. While uncontrolled haemorrhage is a leading cause of preventable injury death in the USA for individuals under 45, military prehospital haemorrhage control techniques have not fully translated to the civilian sector in the USA. The effective implementation of haemorrhage control for civilian prehospital trauma is dependent on a more complex array of system and personnel-level factors than the military.ObjectiveThis protocol describes the methodology of a scoping review on haemorrhage control strategies in the prehospital setting; specifically, education, logistics and implementation of these strategies. The aim of the review is to identify research gaps and create recommendations for future research surrounding prehospital layperson haemorrhage control.MethodsThe protocol uses the framework published by The Joanna Briggs Institute and Arksey and O'Malley, while following the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review Protocols guidelines. The search strategy was refined with the help of a medical librarian. Three peer-reviewed databases (EMBASE, PubMed and Web of Science), databases dedicated to grey literature sources, and reference mining will be used. Two investigators will independently screen and extract data. Discrepancies will be resolved by a third investigator. The extracted data will undergo descriptive analysis of the contextual data and a quantitative analysis using the appropriate statistical methods. In addition, this search strategy will be supplemented by a grey literature search.Ethics and disseminationResearch ethics approval is not required for this scoping review. This scoping review will serve to highlight existing gaps within the literature to guide further research and develop future strategies to improve prehospital haemorrhage management. The results of this review will be presented at relevant national and international conferences and published in a peer-reviewed journal.

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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes.

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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes.

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