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Have patient pathways for penetrating chest injuries improved since designation as a London major trauma centre?
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine volume 21, Article number: S21 (2013)
King’s College Hospital NHS Foundation Trust was designated a Major Trauma Centre for the South East London Trauma Network in April 2010. Penetrating trauma accounts for a high proportion of the Trauma Team caseload at this centre and various initiatives have been made to improve the quality of the major penetrating trauma pathways.
A retrospective cohort study of penetrating chest trauma cases seen by the Trauma Team from April 2010 and April 2011 was compared. Statistical analysis of unpaired means was calculated with the z-test and two-tailed p-values.
25 cases from April, May and June 2010 (100% male, mean age 28.6 years) and 28 cases from April, May and June 2011 (100% male, mean age 24.1 years) were indentified. In 2010, mean time to CXR was 18.86 minutes, 95% CI (12.97, 24.75) and mean time to CT was 93.10 minutes (61.27, 124.93). In 40% of cases use of eFAST was documented. In total, 91.3% underwent CT scanning of the thorax. In February 2011, a Standard Operating Procedure (SOP) was introduced along with pre-registration of patients prior to arrival, use of a designated trauma CT scanner and increased training of eFAST. In 2011, mean time to CXR was 10.45 minutes, 95% CI (7.55, 13.35) and mean time to CT was 46.94 minutes, 95% CI (26.36, 67.52). In 54% of cases use of eFAST was documented. In total, 60.7% of cases underwent CT scanning of the thorax. Comparing this data over time, both time to CXR (p=0.012) and time to CT (p= 0.000024) have significantly decreased along with increased utilisation of eFAST and reduced use of CT scanning in accordance with the SOP.
In the intervening year as a Major Trauma Centre, there is quite strong evidence (p<0.05) for CXR and very strong evidence (p<0.0001) for CT, that time to diagnostic imaging has significantly improved. The introduction of an SOP incorporating physiological parameters and zone of chest injury along with increased use of eFAST has contributed to a reduction in the use of inappropriate CT scanning in accordance with recent evidence-based guidance.
Mollberg NM, Wise SR, De Hoyos AL: Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram. Ann Thorac Surg. 2012, 93 (6): 1830-5. 10.1016/j.athoracsur.2012.02.095.
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Pallett, J., Olding, J., Hurst, T. et al. Have patient pathways for penetrating chest injuries improved since designation as a London major trauma centre?. Scand J Trauma Resusc Emerg Med 21 (Suppl 1), S21 (2013). https://doi.org/10.1186/1757-7241-21-S1-S21
- Standard Operating Procedure
- Major Trauma
- Trauma Team
- Chest Injury
- Major Trauma Centre