Dispatch, Prehospital time, Interventions and Outcomes in a Norwegian Trauma population – assessing initial trauma management in urban and rural areas. The DIONT-project: a national registry-based research protocol (Preprint)

2021 ◽  
Author(s):  
Inger Nilsbakken ◽  
Stephen Sollid ◽  
Torben Wisborg ◽  
Elisabeth Jeppesen
Keyword(s):  
Statistical Methods ◽  
Rural Areas ◽  
Trauma Registry ◽  
Trauma System ◽  
Trauma Patients ◽  
Trauma Management ◽  
Trauma Systems ◽  
Urban And Rural Areas ◽  
Prehospital Time ◽  
The Impact

BACKGROUND Time is considered an essential determinant in the initial care of trauma patients. In Norway, the particular time indicator response time (i.e. time from dispatch center call to ambulance arrival at scene) is a controversial national quality indicator. However, no national requirements for response times have been established. There is an ongoing debate regarding the optimal configuration of the Norwegian trauma system. Recent centralization of trauma services and closure of emergency hospitals have increased distances for prehospital transports, predominantly for rural trauma patients. The impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described. OBJECTIVE The project will assess the injured patient´s initial pathway through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at a national level and existing evidence for an optimal organization of trauma care is still inconclusive regarding the impact of prehospital time. METHODS Three quantitative registry-based retrospective cohort studies are planned. The studies based on data from the Norwegian Trauma Registry (NTR) (Study 1, 2 and 3) and local Emergency Medical Communications Center (EMCC) data (Study 2). All injured adult patients admitted to a Norwegian hospital and registered in the NTR in the period 1st of January 2015 to 31st of December 2020 will be included in the analysis. Trauma registry data will be analyzed using descriptive statistical methods and relevant statistical methods to compare prehospital time in rural and central areas including regression analyses and adjusting for confounders. RESULTS The project received funding autumn 2020 and is approved by the Oslo University Hospital data protection officer, case number 18/02592. Registry data including approximately 40.000 trauma patients will be extracted during the first quarter of 2022 and analysis will begin immediately thereafter. Results are expected to be ready for publication from the third quarter of 2022. CONCLUSIONS : Findings from the study will contribute to new knowledge regarding existing quality indicators and with an increasing centralization of hospitals and residents, the study will contribute to further development of the Norwegian trauma system. A high generalizability to other trauma systems is expected, given the similarities between demographical changes and trauma systems in many high-income countries.

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry

2020 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. Methods: This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. Results: A total of 30,551 patients (physician-led: 2,976, paramedic-led: 27,575) were eligible for analysis, of whom 2,690 propensity score-matched pairs (physician-led: 2,690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1,718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age <65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time <60 min were likely to benefit from physician-led prehospital management. Conclusions: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry

2021 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management.Methods: This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics.Results: A total of 30,551 patients (physician-led: 2,976, paramedic-led: 27,575) were eligible for analysis, of whom 2,690 propensity score-matched pairs (physician-led: 2,690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1,718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age <65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time <60 min were likely to benefit from physician-led prehospital management.Conclusions: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

scholarly journals Effectiveness of Physician-Led Prehospital Management in Severe Trauma Patients: A Retrospective Analysis of the Japanese Nationwide Trauma Registry

2020 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Trauma Registry ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Trauma Management ◽  
Transport Time ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: The comparative effectiveness of physician-led over paramedic-led prehospital trauma management has been inconclusive. Regarding this topic, in some previous studies, the impacts of physician-led prehospital management were affected by the advantage of shortened prehospital time by helicopter transportation. This study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time.Methods: This retrospective cohort study analyzed the data of severe trauma patients who were transported directly to a hospital during 2009–2018 using Japan’s nationwide trauma registry. In-hospital mortality was compared between patients who received physician-led prehospital management and those who received paramedic-led management, using 1:4 propensity score-matched analysis. The propensity score was calculated using information on patient demographics, mechanism of injury, and vital signs at the scene of injury, as well as prehospital transport time. Subgroup analysis was performed to identify patients who were most likely to benefit from physician-led prehospital management.Results: A total of 30,968 patients (physician-led: 3,032, paramedic-led: 27,936) were eligible for analysis, of whom 2,766 propensity score-matched pairs (i.e., physician-led: 2766, paramedic-led: 11,064) were generated and compared. Physician-led pre-hospital trauma management showed significant superiority over paramedic-led prehospital trauma management (in-hospital mortality: 395 [14.3%] and 1785 [16.1%], respectively; odds ratio [95% confidence interval] = 0.87 [0.77–0.97], p = 0.017). In subgroup analysis, cases characterized by patient age <65 years, Injury Severity Score ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and prehospital transport time <60 min likely benefitted from physician-led prehospital management.Conclusions: The result of a largescale registry-based cohort study showed that physician-led prehospital trauma management was significantly associated with survival benefit independent of prehospital transport time. The findings may provide a basis for future research to assess effective physician-provided treatments in prehospital-field.

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: a retrospective analysis of the Japanese nationwide trauma registry

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. Methods This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. Results A total of 30,551 patients (physician-led: 2976, paramedic-led: 27,575) were eligible for analysis, of whom 2690 propensity score-matched pairs (physician-led: 2690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age < 65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time < 60 min were likely to benefit from physician-led prehospital management. Conclusions Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid

2021 ◽  
Vol 195 ◽  
pp. 110892
Author(s):  
J.A. López-Bueno ◽  
M.A. Navas-Martín ◽  
C. Linares ◽  
I.J. Mirón ◽  
M.Y. Luna ◽  
...  
Keyword(s):  
Rural Areas ◽  
Heat Waves ◽  
Daily Mortality ◽  
Urban And Rural Areas ◽  
The Impact

scholarly journals Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047439
Author(s):  
Rayan Jafnan Alharbi ◽  
Virginia Lewis ◽  
Sumina Shrestha ◽  
Charne Miller
Keyword(s):  
Systematic Review ◽  
Trauma Care ◽  
Data Extraction ◽  
Meta Analysis ◽  
Trauma System ◽  
Secondary Data ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Trauma Systems ◽  
Stages Of Development

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

scholarly journals Integrated Passenger Transport System in Rural Areas – A Literature Review

2020 ◽  
Vol 32 (6) ◽  
pp. 863-873
Author(s):  
Branimir Maretić ◽  
Borna Abramović
Keyword(s):  
Literature Review ◽  
Transport System ◽  
Rural Areas ◽  
Urban Areas ◽  
Planning System ◽  
Passenger Transport ◽  
Public Transport System ◽  
Urban And Rural Areas ◽  
Set Up ◽  
The Impact

The planning and organisation of public passenger transport in rural areas is a complex process. The transport demand in rural areas is often low, which makes it hard to establish and run a financially sustainable public transport system. A solution is integrated passenger transport that eliminates deficiencies and provides benefits for all participants in the public passenger transport process. This paper describes the impact of integrated passenger transport on mobility in rural areas and critically evaluates different literature sources. Integration of passenger transport in urban areas has been described in the context of rural areas, and the challenges of integration of public passenger transport specific to rural areas have been analysed. Through the application in urban and rural areas, the planning of integrated and non-integrated passenger transport has been functionally analysed. The analysis found an increase in the degree of mobility in the areas that use integrated passenger transport compared to the non-integrated one. This research of the literature review has identified the rural areas of mobility as under-researched. The mobility research can set up a more efficient passenger transport planning system in rural areas.

Empirical analysis of the impact of financial development on the income gap between urban and rural residents in the context of large data using fuzzy Kmeans clustering algorithm

2020 ◽  
pp. 002072092093683
Author(s):  
Yao Li
Keyword(s):  
Empirical Analysis ◽  
Financial Development ◽  
Rural Areas ◽  
Clustering Algorithm ◽  
Financial Industry ◽  
Rural Residents ◽  
Income Gap ◽  
Urban And Rural Residents ◽  
Urban And Rural Areas ◽  
The Impact

With the rise of the tertiary industry, the financial industry has achieved unprecedented development, which is mainly reflected in the rapid growth of economic aggregate, the increasingly balanced financial structure system and the increasingly diversified financial products. However, with the rapid development of financial industry, the income of urban and rural residents is increasingly unbalanced. The increasing income gap between urban and rural areas has caused a large number of adverse phenomena in the process of economic development, seriously affecting the income distribution of the people and even causing social instability. Therefore, in today’s big data era, it is necessary to systematically study and analyze the impact of financial industry development on the national income gap between urban and rural areas. At the same time, it is of great significance to improve the problem of excessive income gap between urban and rural areas. This paper mainly analyses the relationship between the three effects of the development of financial industry and the income gap between urban and rural residents. In the empirical aspect, the paper creatively uses the fuzzy Kmeans clustering algorithm to regression analysis the panel data of a certain area from 2010 to 2018. At the same time, in the empirical data analysis, this paper creatively replaces the European norm measure of the Kmeans clustering algorithm with the AE measure, and puts forward a proposal. The index of financial development level is based on the proportion of loans from financial institutions. Through theoretical and empirical analysis, this paper draws the following conclusions: the financial scale in the financial industry will have a huge impact on the income gap between urban and rural areas. Finally, based on the above problems and current situation, this paper puts forward relevant improvement suggestions.

scholarly journals Sustainable Mountain Village Construction Adapted to Livelihood, Topography, and Hydrology: A Case of Dong Villages in Southeast Guizhou, China

2018 ◽  
Vol 10 (12) ◽  
pp. 4619
Author(s):  
Zhengxu Zhou ◽  
Ziyu Jia ◽  
Nian Wang ◽  
Ming Fang
Keyword(s):  
Spatial Pattern ◽  
Rural Areas ◽  
Paddy Field ◽  
Sustainable Construction ◽  
Ecological Stability ◽  
Mountain Valley ◽  
Sustainable Environment ◽  
Water Pond ◽  
Urban And Rural Areas ◽  
The Impact

A sustainable environment needs the effort and experience from both urban and rural areas. Some villages have achieved sustainability utilizing the concept of ecological stability. This paper takes the Dong villages in the Duliujiang River Basin in the Southeastern Guizhou as an example. Based on the anthropological “ethnographic text” and the morphological “village space information”, this paper analyzes the impact of the mountain rice livelihood model and different hydrological–topographic conditions on the spatial pattern of settlements, focusing on the sustainable construction wisdom. The findings are as follows: (1) Dong people’s migration follows the “River Valley–Mountain Valley–Mountain Slope” path, with maintenance of the rice livelihood model and, finally, derived from the “Mountain–Water–Forest–Paddy Field–Village” spatial pattern, the “Mountain–Water–(Pond)–Field–Forest–Village”, “Mountain–Water–Terrace–Forest–Village” settlement space patterns are formed. (2) The Dong’s settlements form a sustainable overall space. “Mountain–Water–Forest–Paddy Field” each play an ecological role and form an organic whole. Their management mechanism of utilizing limited natural resources has played an important management and supervision role. (3) The natural base of “Mountain–Water–Forest–Paddy Field–Village” is in accordance with their livelihood model and social culture, forming a unique ecosystem. It has become the basic environment for them to obtain survival sustenance, which still has prominent values today.

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