Does mortality after trauma team activation peak at shift change? |
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| Institution: | 1. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA;1. Children''s University Hospital, Temple St, Rotunda, Dublin 1, D01 XD99, Ireland;2. Cappagh Kids, National Orthopaedic Hospital Cappagh, Cappagh Rd, Cappoge, Dublin 11, D11 EV29 Ireland;3. UCD School of Medicine, University College Dublin, Belfield, Dublin 4 Ireland;1. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy;2. Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D''Aragona, 84131 Salerno, Italy;3. Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK;4. Keele University, Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK;1. Department of General Surgery, Aberdeen Royal Infirmary, United Kingdom;2. Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom;3. Cancer Audit Team, NHS Grampain, United Kingdom;4. Health Services Research Unit, University of Aberdeen, United Kingdom;1. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy;2. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK;3. School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK;4. The London Independent Hospital, London, UK;5. Department of Medical Imaging, The London Independent Hospital, London, UK;1. St. George''s University Hospital, Blackshaw Road Tooting, London, SW17 0QT, United Kingdom;2. University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom;3. Royal Devon and Exeter Hospital, Barrack Road, EX2 5DW, Exeter, United Kingdom;4. Dept of Paediatric Surgery, AIIMS, Raipur, India;1. Department of Surgery, The Chinese University of Hong Kong, Hong Kong;2. Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong;3. Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong |
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| Abstract: | BackgroundPrior institutional data have demonstrated trauma mortality to be highest between 06:00–07:59 at our center, which is also when providers change shifts (07:00–07:30). The objective was definition of patient, provider, and systems variables associated with trauma mortality at shift change among patients arriving as trauma team activations (TTA).MethodsAll TTA patients at our ACS-verified Level I trauma center were included (01/2008–07/2019), excluding those with undocumented arrival time. Study groups were defined by arrival time: shift change (SC) (06:00–07:59) vs. non-shift change (NSC) (all other times). Univariable/multivariable analyses compared key variables. Propensity score analysis compared outcomes after matching.ResultsAfter exclusions, 6020 patients remained: 229 (4%) SC and 5791 (96%) NSC. SC mortality was 25% vs. 16% during NSC (p < 0.001). More SC patients arrived with SBP <90 (19% vs. 11%, p < 0.001) or GCS <9 (35% vs. 24%, p < 0.001). ISS was higher during SC (4332–50] vs. 3427–50], p < 0.001). Time to CT scan (3623–66] vs. 3823–61] minutes, p = 0.638) and emergent surgery (9435–141] vs. 6334–107] minutes, p = 0.071) were comparable. Older age (p < 0.001), SBP <90 (p < 0.001), GCS <9 (p < 0.001), need for emergent operative intervention (p = 0.044), and higher ISS (p < 0.001) were independently associated with mortality. After propensity score matching, mortality was no different between SC and NSC (p = 0.764).ConclusionsEarly morning is a low-volume, high-mortality time for TTAs. Increased mortality at shift change was independently associated with patient/injury factors but not provider/systems factors. Ensuring ample clinical resource allocation during this high acuity time may be prudent to streamline patient care at shift change. |
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| Keywords: | Mortality Trauma team activation Shift change Provider response times Time to intervention |
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