Mitra Biswadev, Mathew Joseph, Gupta Amit, Cameron Peter, O'Reilly Gerard, Soni Kapil Dev, Kaushik Gaurav, Howard Teresa, Fahey Madonna, Stephenson Michael, Kumar Vineet, Vyas Sharad, Dharap Satish, Patel Pankaj, Thakor Advait, Sharma Naveen, Walker Tony, Misra Mahesh Chandra, Gruen Russell, Fitzgerald Mark
National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.
Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
BMJ Open. 2017 Jul 17;7(7):e014073. doi: 10.1136/bmjopen-2016-014073.
Prehospital notification of injured patients enables prompt and timely care in hospital through adequate preparation of trauma teams, space, equipment and consumables necessary for resuscitation, and may improve outcomes. In India, anecdotal reports suggest that prehospital notification, in those few places where it occurs, is unstructured and not linked to a well-defined hospital response. The aim of this manuscript is to describe, in detail, a study protocol for the evaluation of a formalised approach to prehospital notification.
This is a longitudinal prospective cohort study of injured patients being transported by ambulance to major trauma centres in India. In the preintervention phase, prospective data on patients will be collected on prehospital assessment, notification, inhospital assessment, management and outcomes and recorded in a new tailored multihospital trauma registry. All injured patients arriving by ambulance and allocated to a red or yellow priority category will be eligible for inclusion. The intervention will be a prehospital notification application to be used by ambulance clinicians to notify emergency departments of the impending arrival of a patient. The proportion of eligible patients arriving to hospital after notification will be the primary outcome measure. Secondary outcomes evaluated will be availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray and inhospital mortality.
Ethical approval has been obtained from the All India Institute of Medical Sciences, New Delhi and site-specific approval granted by relevant trauma services. The trial has also been registered with the Monash University Human Research and Ethics Committee; Project number: CF16/1814 - 2016000929. Results will be fed back to prehospital and hospital clinicians via a series of reports and presentations. These will be used to facilitate discussions about service redesign and implementation. It is expected that evidence for improved outcomes will enable widespread adoption of this intervention among centres in all settings with less established tools for prehospital assessment and notification.
NCT02877342; Pre-results.
对受伤患者进行院前通知，可通过充分准备创伤团队、空间、复苏所需设备和耗材，使医院能及时提供救治，这可能改善治疗结果。在印度，有传闻称，在少数进行院前通知的地方，通知方式无章可循，且与明确的医院应对措施没有关联。本手稿的目的是详细描述一项研究方案，以评估一种正式的院前通知方法。
这是一项针对印度通过救护车转运至主要创伤中心的受伤患者的纵向前瞻性队列研究。在干预前阶段，将收集患者的院前评估、通知、院内评估、治疗及结果等前瞻性数据，并记录在新定制的多医院创伤登记系统中。所有通过救护车送达且被分配为红色或黄色优先类别的受伤患者均符合纳入标准。干预措施将是一款院前通知应用程序，供救护车临床医生用于通知急诊科患者即将到达。通知后到达医院的符合条件患者的比例将作为主要结局指标。评估的次要结局指标将包括创伤病房的可用性、患者到达时创伤团队的在场情况、首次胸部X光检查的时间以及院内死亡率。
已获得新德里全印度医学科学研究所的伦理批准以及相关创伤服务部门的特定地点批准。该试验也已在莫纳什大学人类研究与伦理委员会注册；项目编号：CF16/1814 - 2016000929。研究结果将通过一系列报告和演示反馈给院前及医院临床医生。这些将用于促进关于服务重新设计和实施的讨论。预计改善治疗结果的证据将促使所有环境中缺乏成熟院前评估和通知工具的中心广泛采用这一干预措施。
NCT02877342；预结果。
