Prehospital notification of injured patients presenting to a trauma centre in India: A prospective cohort study

Biswadev Mitra; Vineet Kumar; Gerard O'Reilly; Peter Cameron; Amit Gupta; Amol P. Pandit; Kapil D. Soni; Gaurav Kaushik; Joseph Mathew; Joseph Mathew; Joseph Mathew; Teresa Howard; Teresa Howard; Madonna Fahey; Michael Stephenson; Michael Stephenson; Michael Stephenson; Satish Dharap; Pankaj Patel; Advait Thakor; Naveen Sharma; Tony Walker; Mahesh C. Misra; Russell L. Gruen; Mark C. Fitzgerald

doi:10.1136/bmjopen-2019-033236

Prehospital notification of injured patients presenting to a trauma centre in India: A prospective cohort study

Biswadev Mitra^*, Vineet Kumar, Gerard O'Reilly, Peter Cameron, Amit Gupta, Amol P. Pandit, Kapil D. Soni, Gaurav Kaushik, Joseph Mathew, Joseph Mathew, Joseph Mathew, Teresa Howard, Teresa Howard, Madonna Fahey, Michael Stephenson, Michael Stephenson, Michael Stephenson, Satish Dharap, Pankaj Patel, Advait ThakorNaveen Sharma, Tony Walker, Mahesh C. Misra, Russell L. Gruen, Mark C. Fitzgerald

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objectives To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. Design Longitudinal prospective cohort study with preintervention and postintervention cohorts. Setting Major trauma centre in India. Participants Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. Intervention A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. Main outcome measures The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. Results Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). Conclusions The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. Trial registration number NCT02877342.

Original language	English
Article number	e033236
Journal	BMJ Open
Volume	10
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2019-033236
Publication status	Published - 21 Jun 2020

Access to Document

10.1136/bmjopen-2019-033236

Cite this

Mitra, B., Kumar, V., O'Reilly, G., Cameron, P., Gupta, A., Pandit, A. P., Soni, K. D., Kaushik, G., Mathew, J., Mathew, J., Mathew, J., Howard, T., Howard, T., Fahey, M., Stephenson, M., Stephenson, M., Stephenson, M., Dharap, S., Patel, P., ... Fitzgerald, M. C. (2020). Prehospital notification of injured patients presenting to a trauma centre in India: A prospective cohort study. BMJ Open, 10(6), Article e033236. https://doi.org/10.1136/bmjopen-2019-033236

@article{0a503b31e89b4380b9e0671f0419d4b8,

title = "Prehospital notification of injured patients presenting to a trauma centre in India: A prospective cohort study",

abstract = "Objectives To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. Design Longitudinal prospective cohort study with preintervention and postintervention cohorts. Setting Major trauma centre in India. Participants Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. Intervention A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. Main outcome measures The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. Results Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). Conclusions The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. Trial registration number NCT02877342.",

keywords = "ambulance, mortality, notification, pre-hospital, wounds and injuries",

author = "Biswadev Mitra and Vineet Kumar and Gerard O'Reilly and Peter Cameron and Amit Gupta and Pandit, {Amol P.} and Soni, {Kapil D.} and Gaurav Kaushik and Joseph Mathew and Joseph Mathew and Joseph Mathew and Teresa Howard and Teresa Howard and Madonna Fahey and Michael Stephenson and Michael Stephenson and Michael Stephenson and Satish Dharap and Pankaj Patel and Advait Thakor and Naveen Sharma and Tony Walker and Misra, {Mahesh C.} and Gruen, {Russell L.} and Fitzgerald, {Mark C.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = jun,

day = "21",

doi = "10.1136/bmjopen-2019-033236",

language = "English",

volume = "10",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "6",

}

Mitra, B, Kumar, V, O'Reilly, G, Cameron, P, Gupta, A, Pandit, AP, Soni, KD, Kaushik, G, Mathew, J, Mathew, J, Mathew, J, Howard, T, Howard, T, Fahey, M, Stephenson, M, Stephenson, M, Stephenson, M, Dharap, S, Patel, P, Thakor, A, Sharma, N, Walker, T, Misra, MC, Gruen, RL & Fitzgerald, MC 2020, 'Prehospital notification of injured patients presenting to a trauma centre in India: A prospective cohort study', BMJ Open, vol. 10, no. 6, e033236. https://doi.org/10.1136/bmjopen-2019-033236

TY - JOUR

T1 - Prehospital notification of injured patients presenting to a trauma centre in India

T2 - A prospective cohort study

AU - Mitra, Biswadev

AU - Kumar, Vineet

AU - O'Reilly, Gerard

AU - Cameron, Peter

AU - Gupta, Amit

AU - Pandit, Amol P.

AU - Soni, Kapil D.

AU - Kaushik, Gaurav

AU - Mathew, Joseph

AU - Howard, Teresa

AU - Fahey, Madonna

AU - Stephenson, Michael

AU - Dharap, Satish

AU - Patel, Pankaj

AU - Thakor, Advait

AU - Sharma, Naveen

AU - Walker, Tony

AU - Misra, Mahesh C.

AU - Gruen, Russell L.

AU - Fitzgerald, Mark C.

PY - 2020/6/21

Y1 - 2020/6/21

N2 - Objectives To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. Design Longitudinal prospective cohort study with preintervention and postintervention cohorts. Setting Major trauma centre in India. Participants Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. Intervention A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. Main outcome measures The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. Results Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). Conclusions The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. Trial registration number NCT02877342.

AB - Objectives To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. Design Longitudinal prospective cohort study with preintervention and postintervention cohorts. Setting Major trauma centre in India. Participants Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. Intervention A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. Main outcome measures The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. Results Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). Conclusions The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. Trial registration number NCT02877342.

KW - ambulance

KW - mortality

KW - notification

KW - pre-hospital

KW - wounds and injuries

UR - http://www.scopus.com/inward/record.url?scp=85086789414&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2019-033236

DO - 10.1136/bmjopen-2019-033236

M3 - Article

SN - 2044-6055

VL - 10

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e033236

ER -

Prehospital notification of injured patients presenting to a trauma centre in India: A prospective cohort study

Abstract

Access to Document

Other files and links

Fingerprint

Cite this